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David B. Shurtleff - One of the best experts on this subject based on the ideXlab platform.

  • comparative study of Meningomyelocele repair or cerebrospinal fluid shunt as primary treatment in spina bifida
    Developmental Medicine & Child Neurology, 2008
    Co-Authors: David B. Shurtleff, E L Foltz
    Abstract:

    SUMMARY From a study of 119 children with Meningomyelocele who were treated in different ways, it is reported that there is a definite advantage in controlling the hydrocephalus before considering local myelodysplasia repair. This approach significantly reduced central nervous system infection and local myelodysplasia repair breakdown rates. Repair of the lesion was unnecessary in 40 per cent of the children treated first by control of the hydrocephalus. The authors recommend primary control of CSF hypertension, with closure of only widely opened dysplastic areas as an emergency measure. There may subsequently be indications for late surgical repair, such as a persistent or enlarging sac, progressive neurological deterioration of the lower limbs, or family concern. Resume Etude compareee de la reparation du Meningomyelocele et de la deviation du liquide cerebrospinal en tant que premier traitement de Spina Bifida l'etude de 119 enfants avec un Meningomyelocele traites de facons differentes a montre qu'il y avait un avantage certain a controler l'hydrocephalie avant d'envisager la reparation de la myelodysplasie locale. Cette methode reduit de facon significative le taux d'infection du systeme nerveux central et des defaillances des reparations de la myelodysplasie locale. II n'a pas ete necessaire de reparer la lesion chez 50 pour cent des enfants qui avaient ete traites d'abord pour controler l'hydrocephalie. Les auteurs recommandent de controler d'abord l'hypertension du LCR, avec fermeture de la region myelodysplastique en tant que mesure d'urgence. Une reparation surgicale tardive peut etre indiquee par la suite, par exemple par un sac persistant ou s'aggrandissant, une deterioration neurologique progressive des membres inferieurs, ou l'inquietude de la famille. ZUSAMMENFASSUNG Vergleichsstudie von Meningomyelozele-Reparatur oder zerebrospinalem Flussigkeits-Shunt als primare Behandlung hie Spina bifida Aus einer Studie von 119 Kindern mit Meningomyelozele, die auf verschiedene Arten behandelt wurden, geht hervor, dass es unbedingt vorteilhaft ist, uber den Hydrozephalus Kontrolle auszuuben, bevor man lokale Myelodysplasie-Reparatur in Betracht zieht. Diese Methode reduzierte bedeutsam zentrale Nervensystem-Infektion und die Zusammen-bruchs-Raten lokaler Myelodysplasie-Reparatur. Reparatur der Lasion erubrigte sich in 40 Prozent der Kinder, die zuerst durch Hydrozephalus-Kontrollierung behandelt wurden. Die Verfasser empfehlen primare Kontrollierung des CSF-Hochdruckes verbunden mit Schliessung der myelodysplastischen Zone als eine Notmassnahme. Es konnen in der Folge Anzeichen fur spatere chirurgische Reparatur entstehen, wie eine hartnackige oder sich vergrossernde Tasche, progressive neurologische Verschlechterung der unteren Gliedmassen oder Besorgtheit der Familie.

  • Anatomy of the spinal cord in patients with Meningomyelocele with and without hypoplasia or hydromyelia
    European Journal of Pediatric Surgery, 1998
    Co-Authors: D. Moskowitz, David B. Shurtleff, E. Weinberger, John D. Loeser
    Abstract:

    We compared the cross-sectional areas of spinal cords of patients with normal cords to the area of patients with Meningomyelocele. The control group consisted of examinations of 27 patients with normal spinal cords providing 1547 axial images at 20 levels, C2-L2. The Meningomyelocele group consisted of 67 MRI examinations of 41 patients, providing 4,095 axial images at 23 levels C2 to S1. Thirty-four examinations were of 21 patients with minimal hydromyelia, 7 examinations were of 3 patients with operable hydromyelia, and 26 examinations were of 17 patients without hydromyelia. In an additional analysis, we selected those Meningomyelocele patients with cord tethering but without hydromyelia or hypoplasia (53 examinations of 30 patients) and compared them to symptomatic hypoplasia cases (9 examinations of 6 patients). The symptomatic hypoplasia cases were chosen because of progressive loss of muscle strength and worsening spasticity not relieved by surgical adhesiolysis. The test, retest error was 5.6% with differences between the means of repeated readings not being significant. All tests for significance were paired T test. The areas of spine levels C7-L2 for the controls were significantly larger than for the Meningomyelocele patients (p = 0.000007). Including all levels C2-S1, the minimal hydromyelia cases were not significantly different from those without hydromyelia (p = 0.5). The areas C2-S1 of operable hydromyelia cases were larger than both non-shunted minimal hydromyelia (p = 0.00009) and of Meningomyelocele patients without hydromyelia (p = 0.00003). The areas C7-L2, of hypoplasia cases were significantly smaller compared to the "normal" Meningomyelocele cases (p = 0.0004). These data suggest that hydromyelia stimulates overgrowth of the cord, as does hydrocephalus of the brain, and that adhesiolysis procedures are of no value with hypoplasia of the spinal cord.

  • Epidemiology of tethered cord with Meningomyelocele.
    European Journal of Pediatric Surgery, 1997
    Co-Authors: David B. Shurtleff, Sharon Duguay, G Duguay, D. Moskowitz, E. Weinberger, T Roberts, John D. Loeser
    Abstract:

    This paper describes the epidemiology of tethered cord syndrome and its etiologies and co-morbidities following initial repair of both Meningomyeloceles and lipoMeningomyelocele. A review of the pertinent literature and data from 654 cases of Meningomyelocele and 118 cases of lipoMeningomyelocele has been drawn from a computerized database, Patient Data Management System/fx. Only cases born since 1964 were analyzed for the etiologies, co-morbidities, spinal cord abnormalities detected by contrast studies or MRI and for significant symptoms and signs. Tethered cord symptoms were related to an attachment to a rigid tether for all 31 cases following lipoMeningomyelocele repair but 62 (75%) of the 83 post Meningomyelocele repair patients developed the symptoms of tethered cord. Causes other than, or in addition to, tethering included an obstructed cerebrospinal fluid shunt, syringohydromyelia, benign tumor and spinal cord hypoplasia. Quantitative differentiation between asymptomatic thin spinal cords and symptomatic spinal cord hypoplasia as well as between central canal enlargement and symptomatic syringohydromyelia could not be demonstrated. Collaborative, multi-center studies of larger numbers of patients are recommended.

  • CESAREAN SECTION BEFORE THE ONSET OF LABOR AND SUBSEQUENT MOTOR FUNCTION IN INFANTS WITH Meningomyelocele DIAGNOSED ANTENATALLY
    New England Journal of Medicine, 1991
    Co-Authors: David A. Luthy, David B. Shurtleff, Terrance Wardinsky, Kathryn A. Hollenbach, Durlin E. Hickok, David A. Nyberg, Thomas J. Benedetti
    Abstract:

    Abstract Background. Meningomyelocele can now be detected before birth. Few data are available on its natural history, however, and optimal management at the time of delivery is controversial, although it has been suggested that labor and vaginal delivery may cause pressure on exposed nerve roots, resulting in additional loss of neural function. Methods. To assess the effect of labor and the type of delivery on the level of motor function in fetuses with uncomplicated Meningomyelocele, we identified 200 cases of this disorder, accounting for 95 percent of the cases that occurred in the state of Washington during our 10-year study period. We compared the outcomes of 47 infants delivered by cesarean section before labor began, 35 delivered by cesarean section after a period of labor, and 78 who were delivered vaginally (another 40 were ineligible for the study). In cases of Meningomyelocele detected prenatally, cesarean section was performed before the onset of labor if isolated Meningomyelocele without sev...

John L Emery - One of the best experts on this subject based on the ideXlab platform.

  • the position of the spinal cord segments related to the vertebral bodies in children with Meningomyelocele and hydrocephalus
    Developmental Medicine & Child Neurology, 2008
    Co-Authors: D R Naik, John L Emery
    Abstract:

    UMMARY By transfixing the spinal cord with small steel pins in situ and then taking radiographs of the spine, the authors were able to measure the lengths of the spinal neural segments in both normal children and those with Meningomyeloceles at a variety of levels, and to relate the spinal cord level with the vertebral bodies. They found that, in children with Meningomyeloceles, the positions of the spinal cord segments are normal in the upper thoracic level. The segments are compressed in the cervical spines and, in the lower thoracic and lumbar levels, the segments cephalad to the meningocele are elongated and displaced caudally in such a way as to suggest that the cranial displacement of the lumbar cord segments normally occurring during later intrauterine life does not take place in the presence of a Meningomyelocele. RESUME En transpercant la moelle epiniere avec des petites epingles d'acier in situ, puis en radiographiant la colonne vertebrale, les auteurs ont pu mesurer les longueurs des segments neuraux rachidiens chez les enfants normaux et chez les enfants atteints de Meningomyeloceles a differents niveaux, ils ont pu alors rappoiter le niveau de la moelle epiniere aux corps vertebraux. Ils ont trouve que, chez les enfants atteints de menigomyeloceles, les positions des segments de la moelle epiniere sont normaux au niveau du thorax superieur. Les segments sont compresses dans les vertebres cervicales et, aux niveaux thoracique inferieur et lombaire, les segments orientes vers la tete du Meningomyelocele sont etires et deplaces caudalement de facon a suggerer que le deplacement cranien des segments de la moelle lombaire qui a lieu normallement vers la fin de la vie uterine n'a pas ete effectue presence d'un Meningomyelocele. ZUSAMMENFASSUNG Indem das Ruckenmark mit kleinen Stahlnadeln in situ durchstochen und danach eine Rontgenaufnahme genommen wurde, war es den Autoren moglich, die Langen der spinalen Neuralsegmente sowohl bei normalen Kindern als auch bei den mit Meningomyelocelen behafteten, an verschiedenen Punkten zu messen und das Ruckenmarksniveau mit den Vertebralkorpern in Beziehung zu bringen. Sie stellten fest, dass bei Kindern mit Meningomyelocelen, die Ruckenmarkssegemente sich normalerweise auf dem Niveau des oberen Thorakalraumes befinden. Die Segmente sind in den Halswirbeln zusammengepresst und auf dem unteren Thorakal-und Lumbalniveau, kopfwarts in Richtung der Meningomyelocele, verlangert und dermassen caudal verlagert, dass man annehmen kann, dass die kraniale Verlagerung der Lumbalschnursegmente, die sich normalerweise wahrend des spateren Teils der vorgeburtlichen Zeit ereignet, in der Anwesenheit von Meningomyelocele ausbleibt. RESUMEN Por medio de traspasar la medula espinal con pequenos alfileres de acero en sitio, y de tomar despues radiografias del raquis, los autores pudieron medir la longitud de los segmentos neurales en ninos sanos y tambien en ninos afectos de un mielomeningocele a varies niveles, y establecer relaciones entre el nivel de la medula espinal y los cuerpos vertebrales. Hallaron que en ninos con un mielomeningocele las posiciones de los segmentos de la medula espinal son normales en la zona toracica superior. En la zona cervical los segmentos son comprimidos, y en la zona toracica inferior y la zona lumbar los segmentos cefalicos al mielomeningocele son extendidos y dislocados caudalmente, de manera que sugiere que la orientacion craneal de los segmentos de la medula lumbar, la cual ocurre normalmente durante las ultimas fases de la vida intrauterina, no tenga lugar donde hay un mielomeningocele.

  • the movement of the brain stem and vessels around the brain stem in children with hydrocephalus and the arnold chiari deformity
    Developmental Medicine & Child Neurology, 2008
    Co-Authors: John L Emery, Richard K Levick
    Abstract:

    SUMMARY Post-mortem angiography and dissection of the large vessels and tissues of the brain stem was carried out on 25 children with the Arnold Chiari deformity. An abnormal descent and looping of the basilar arteries was seen, and a very considerable downward looping of the posterior cerebellar vessels occurred in association with the descent of the cerebellum into the spinal cord canal. Measurements at dissection indicated an average descent of the vertebral arteries and pons of 10 mm. in children with thoracolumbar and 3 mm. with lumbosacral Meningomyeloceles. There was a comparable descent of the base of the 4th ventricle of 30 mm. with thoracolumbar Meningomyeloceles and 23 mm. with lumbosacral Meningomyeloceles. RESUME Le deplacement du tronc cerebral et des vaisseaux autour du tronc cerebral chei les enfants atteints d'hydrocephalic et de la difformite d'Arnold Chiari Angiographic post-mortem et dissection des grands vaisseaux et des tissus du tronc cerebral ont ete pratiquees chez 25 enfants atteints de la difformite d'Arnold Chiari. Une descente et une courbure anormales ont eacute;te notees dans les arteres basilaires, et une tres importante courbure vers le bas des vaisseaux cerebelleux etait associee a la descente du cervelet dans le canal rachidien. Des mesures effectuees lors de la dissection ont indique une descente moyenne des arteres vertebrales et des apophyses de 10 mm. chez les enfants atteints de Meningomyeloceles thoraco-lombaires, et de 3 mm. chez ceux atteints de myeloceles lombo-sacres. II y avait une descente comparable de la base du 4 ene ventricule de 30 mm. avec Meningomyeloceles thoraco-lombaires et 23 mm. avec Meningomyeloceles lombo-sacres. ZUSAMMENFASSUNG Bewegung des Gehirnstamms unci der Gefasse urn den Gehirnstamm bei Kindern mil Hydrocephalus und der Arnold Chiari Deformitat Post-mortem Angiographic und Dissektion der grossen Gefasse und Gewebe des Gehirnstamms wurden bei 25 mit der Arnold Chiari DeformitAt behafteten Kindern ausgefUhrt. Eine abnorme Senkung und Verschleifung der Basilar-Arterien wurde fest-gestellt, und eine ausserst bedeutsame Abwartsverschleifung der posterioren Gehirngefasse trat auf, in Verbindung mit dem Herabsinken des Cerebellums in den Ruckenmarkskanal. Messungen bei der Dissektion ergaben eine Durschnitts-Senkung der vertebralen Arterien und pons von 10 mm. bei Kindern mit thoraco-lumbarer und 3 mm. bei lumbo-sacraler Meningomyeloceles. Es gab eine vergleichbare Senkung des Bodens der 4. Gehirnkammer von 30 mm. bei thoraco-lumbarer Meningomyeloceles und 23 mm. bei lumbo-sacraler Meningomyeloceles. RESUMEN Movimienlos del tronco cerebral y de los vasos alrededor del tronco cerebral en ninos que padecen de hidrocefalia o de la defonnidad de Arnold Chiari Despues de la muerte, se hicieron una angiografia y una diseccion de los vasos grandes y de los tejidos del tronco cerebral en 25 ninos que habian padecido de la deformidad de Arnold Chiari. Se vieron un descenso y una curvatura anormales de los troncos basilares, ademas de un descenso y una curvatura muy considerables de los vasos cerebelosos posteriores, con un descenso del cerebro en el conducto de la medula espinal. Las medidas tomadas durante la diseccion revelaron un descenso medio de las arterias verticales y del puente de Varolio de 10 mms. en los ninos que tenian meningomielocclcs toracico-lumbares, y de 3 mms. en los ninos que tenian meningomieloceles Iumbar-sacras. Se hallo igualmente un descenso de la base del cuarto ventriculo de 30 mms. en los ninos que tenian meningomieloceles toracico-lumbares, y de 23 mms. en los ninos que tenian meningomieloceles Iumbar-sacras.

E L Foltz - One of the best experts on this subject based on the ideXlab platform.

  • comparative study of Meningomyelocele repair or cerebrospinal fluid shunt as primary treatment in spina bifida
    Developmental Medicine & Child Neurology, 2008
    Co-Authors: David B. Shurtleff, E L Foltz
    Abstract:

    SUMMARY From a study of 119 children with Meningomyelocele who were treated in different ways, it is reported that there is a definite advantage in controlling the hydrocephalus before considering local myelodysplasia repair. This approach significantly reduced central nervous system infection and local myelodysplasia repair breakdown rates. Repair of the lesion was unnecessary in 40 per cent of the children treated first by control of the hydrocephalus. The authors recommend primary control of CSF hypertension, with closure of only widely opened dysplastic areas as an emergency measure. There may subsequently be indications for late surgical repair, such as a persistent or enlarging sac, progressive neurological deterioration of the lower limbs, or family concern. Resume Etude compareee de la reparation du Meningomyelocele et de la deviation du liquide cerebrospinal en tant que premier traitement de Spina Bifida l'etude de 119 enfants avec un Meningomyelocele traites de facons differentes a montre qu'il y avait un avantage certain a controler l'hydrocephalie avant d'envisager la reparation de la myelodysplasie locale. Cette methode reduit de facon significative le taux d'infection du systeme nerveux central et des defaillances des reparations de la myelodysplasie locale. II n'a pas ete necessaire de reparer la lesion chez 50 pour cent des enfants qui avaient ete traites d'abord pour controler l'hydrocephalie. Les auteurs recommandent de controler d'abord l'hypertension du LCR, avec fermeture de la region myelodysplastique en tant que mesure d'urgence. Une reparation surgicale tardive peut etre indiquee par la suite, par exemple par un sac persistant ou s'aggrandissant, une deterioration neurologique progressive des membres inferieurs, ou l'inquietude de la famille. ZUSAMMENFASSUNG Vergleichsstudie von Meningomyelozele-Reparatur oder zerebrospinalem Flussigkeits-Shunt als primare Behandlung hie Spina bifida Aus einer Studie von 119 Kindern mit Meningomyelozele, die auf verschiedene Arten behandelt wurden, geht hervor, dass es unbedingt vorteilhaft ist, uber den Hydrozephalus Kontrolle auszuuben, bevor man lokale Myelodysplasie-Reparatur in Betracht zieht. Diese Methode reduzierte bedeutsam zentrale Nervensystem-Infektion und die Zusammen-bruchs-Raten lokaler Myelodysplasie-Reparatur. Reparatur der Lasion erubrigte sich in 40 Prozent der Kinder, die zuerst durch Hydrozephalus-Kontrollierung behandelt wurden. Die Verfasser empfehlen primare Kontrollierung des CSF-Hochdruckes verbunden mit Schliessung der myelodysplastischen Zone als eine Notmassnahme. Es konnen in der Folge Anzeichen fur spatere chirurgische Reparatur entstehen, wie eine hartnackige oder sich vergrossernde Tasche, progressive neurologische Verschlechterung der unteren Gliedmassen oder Besorgtheit der Familie.

Ricardo G Hahn - One of the best experts on this subject based on the ideXlab platform.

John D. Loeser - One of the best experts on this subject based on the ideXlab platform.

  • Anatomy of the spinal cord in patients with Meningomyelocele with and without hypoplasia or hydromyelia
    European Journal of Pediatric Surgery, 1998
    Co-Authors: D. Moskowitz, David B. Shurtleff, E. Weinberger, John D. Loeser
    Abstract:

    We compared the cross-sectional areas of spinal cords of patients with normal cords to the area of patients with Meningomyelocele. The control group consisted of examinations of 27 patients with normal spinal cords providing 1547 axial images at 20 levels, C2-L2. The Meningomyelocele group consisted of 67 MRI examinations of 41 patients, providing 4,095 axial images at 23 levels C2 to S1. Thirty-four examinations were of 21 patients with minimal hydromyelia, 7 examinations were of 3 patients with operable hydromyelia, and 26 examinations were of 17 patients without hydromyelia. In an additional analysis, we selected those Meningomyelocele patients with cord tethering but without hydromyelia or hypoplasia (53 examinations of 30 patients) and compared them to symptomatic hypoplasia cases (9 examinations of 6 patients). The symptomatic hypoplasia cases were chosen because of progressive loss of muscle strength and worsening spasticity not relieved by surgical adhesiolysis. The test, retest error was 5.6% with differences between the means of repeated readings not being significant. All tests for significance were paired T test. The areas of spine levels C7-L2 for the controls were significantly larger than for the Meningomyelocele patients (p = 0.000007). Including all levels C2-S1, the minimal hydromyelia cases were not significantly different from those without hydromyelia (p = 0.5). The areas C2-S1 of operable hydromyelia cases were larger than both non-shunted minimal hydromyelia (p = 0.00009) and of Meningomyelocele patients without hydromyelia (p = 0.00003). The areas C7-L2, of hypoplasia cases were significantly smaller compared to the "normal" Meningomyelocele cases (p = 0.0004). These data suggest that hydromyelia stimulates overgrowth of the cord, as does hydrocephalus of the brain, and that adhesiolysis procedures are of no value with hypoplasia of the spinal cord.

  • Epidemiology of tethered cord with Meningomyelocele.
    European Journal of Pediatric Surgery, 1997
    Co-Authors: David B. Shurtleff, Sharon Duguay, G Duguay, D. Moskowitz, E. Weinberger, T Roberts, John D. Loeser
    Abstract:

    This paper describes the epidemiology of tethered cord syndrome and its etiologies and co-morbidities following initial repair of both Meningomyeloceles and lipoMeningomyelocele. A review of the pertinent literature and data from 654 cases of Meningomyelocele and 118 cases of lipoMeningomyelocele has been drawn from a computerized database, Patient Data Management System/fx. Only cases born since 1964 were analyzed for the etiologies, co-morbidities, spinal cord abnormalities detected by contrast studies or MRI and for significant symptoms and signs. Tethered cord symptoms were related to an attachment to a rigid tether for all 31 cases following lipoMeningomyelocele repair but 62 (75%) of the 83 post Meningomyelocele repair patients developed the symptoms of tethered cord. Causes other than, or in addition to, tethering included an obstructed cerebrospinal fluid shunt, syringohydromyelia, benign tumor and spinal cord hypoplasia. Quantitative differentiation between asymptomatic thin spinal cords and symptomatic spinal cord hypoplasia as well as between central canal enlargement and symptomatic syringohydromyelia could not be demonstrated. Collaborative, multi-center studies of larger numbers of patients are recommended.