Myelomeningocele repair complications

• The repair of large meningomyelocele defects using perforator artery-based non-island fasciocutaneous flaps
• Endoscopic assessment of ventricular anomalies diagnosed by MRI in hydrocephalus associated with myelomeningocele
• Differences in brain development and need for CSF diversion based on MMC level: Comparison between prenatal and postnatal repair
• Benefits and complications of fetal and postnatal surgery for open spina bifida: systematic review and proportional meta-analysis
• Safety and Effectiveness of Fetal Myelomeningocele Repair: Case Series Analysis Using an Exteriorized Uterus and a Fetoscopic Approach
• A "Smurf-Cap" head requiring total cranial vault reshaping. A novel syndromic presentation of craniofrontonasal dysplasia associated with spina bifida
• Comparative analysis of bipedicled fasciocutaneous flaps in meningomyelocele repair: influence of perforator preservation on postoperative outcomes and hospitalization duration
• Impact of surgical timing and concomitant anomalies on neonatal meningomyelocele outcomes: a single-center experience

A 12-day-old female, who underwent prenatal Myelomeningocele repair via a two-layer closure (dural replacement patch, primary skin closure), was born at 34 weeks' gestation. Her Group B streptococcal infection positive mother received appropriate antepartum prophylactic antibiotics. She remained stable until day 11 of life when she underwent rapid clinical deterioration. Despite aggressive intervention, she expired on day 12. Review of placental pathology showed maternal and fetal inflammatory response. Autopsy revealed Gram-positive cocci and inflammation within the basilar leptomeninges and lumbosacral region. Neural and dermal elements were present within the MMC repair. This case documents integration of the dermal matrix patch to neural elements, adhering the spinal cord to scar tissue, the clinical implications of which remain unclear ¹⁾.

A two-year-old born with myelomeningocele (MMC), repaired at birth, developed progressive MMC-associated kyphoscoliosis. Elective insertion of a rib-to-pelvis 'Eiffel Tower' bilateral VEPTR growing rods construct was performed without initial complication. Prominence of the right VEPTR sleeve and Dunn-McCarthy hook side-to-side connector resulted in breakdown of overlying poor-quality soft tissues, necessitating washout, partial implant removal, intravenous antibiotic therapy and delayed primary wound closure. A patient-specific 3D-PM, utilising pre-operative CT spine and pelvis 3D-reconstructions, allowed pre-operative formation of a contoured implant, which was inserted without need for further revision.

Results: The patient underwent further VEPTR lengthening without recurrent infection, wound breakdown or implant failure at 24-month follow-up. Satisfactory control of the deformity has been achieved with continued improvement in sitting height and radiographic indices.

Conclusion: This case illustrates the possibility, in certain cases, of using 3D-PM to develop complex components of spinal implant systems pre-operatively, removing the time and difficulty of intra-operative contouring. Consequently, custom-contoured implants may be produced, sterilised and implanted. This technique may be an option, in infants, including MMC-associated kyphoscoliosis, where midline fixation is not possible ²⁾