Neurosurgical Treatment
Neurosurgeon involvement in the care of the individual with spina bifida begins with a prenatal visit. Studies regarding prenatal surgical closure of a neural tube defect are underway.
To date, intrauterine repair has not been shown to decrease the motor deficits associated with myelomeningocele, but in some series it has been demonstrated to decrease the degree of associated Chiari type II malformations and the need for shunting procedures for hydrocephalus in the first year of life (75-78).Neurosurgical repair of an open neural tube defect, such as a cystic lesion, is usually performed on the first day of life. If hydrocephalus is present at birth, surgical management may be necessary. Ninety-five percent of children with spina bifida are likely to have hydrocephalus, and 75% to 85% require surgical management. The average revision rate is 30% to 50% (79), and after 2 years of age there is a 10% per year risk of failure (64). Most neurosurgeons believe that a child with hydrocephalus that required shunting will remain shunt-dependent (65,80). These statistics may change as endoscopic third ventriculostomy with choroid plexus cautery is performed with increasing frequency.
Neurosurgical follow-up is required, even after the neonatal period, to monitor for symptomatic hydrocephalus, shunt malfunction, and other neurosurgical complications. Pediatric patients with myelomeningocele should be followed routinely, usually on an annual basis.