{"id":"ceb72207-bab5-4a49-b97a-aec9bae79d9d","slug":"como-lo-hago-yo-myelomeningocele","title":"Como Lo Hago Yo: Myelomeningocele","authors":["Jorge Lazareff"],"abstract":"Fortificación con ádico fólico es efectiva, pero aún falta conciencia en los jóvenes. La legalidad del aborto aumenta la importancia de la consulta prenatal. Realizo la cirugía bajo microcoscopio por razones didácticas. Irrigación continua para reducir la temperatura del tejido. Trato a la plaqueta como tejido viable. No suturo la plaqueta. No cierro músculo. ATB por una semana después de cirugía. Hidrocefalia: Válvula en todos los casos de ventriculomegalia. Médula anclada: Desanclar una sola vez. Chiari II: Revisar la válvula. Incluir en el seguimiento rendimiento escolar, puede indicar obstrucción de la válvula o médula anclada. In the US the incidence of myelomeningocele (MMCL) is low, about 1/1200 live birth. This could be due to an active public health plant that mandates fortification of food with folic acid, and it also can be due to that in the US abortion is legal. In my opinion, and I state it with out anything else but empirical observations, young couples are not fully aware that they need to take folic acid before becoming pregnant. Even though there is clear evidence pointing towards the advantage of folic acid on reducing the incidence of MMCL we should not fall into easy comfort. There may be other factors that need to be defined. That abortion is legal has created a particular situation in the US, that of prenatal consultation. The parents alerted by the findings on the ultrasound schedule and appointment with a neurosurgeon sometimes together with a neonatologist and a neurologist. In the meeting the implications of a lesion sac filled with fluid in the bac of the fetus are discussed. I say lumbar or lumbar sacral area because we I can’t remember the last time I saw a child with a thoracic MMCL. We all understand that the hurried meeting is called to help the family make a decision within the time frame when abortion is permitted. I conduct the conversation not as if I was reading from a textbook. My first words are to congratulate them for the child, then enquire if we now the gender of the unborn and even if it their first child and even if they have thought of a name. I don’t minimize the seriousness of the lesions, stress on the absolute certainty of sphincter damage, I am more reserved about the putative motor impairment but still I never give the impression that the child will not have to face some handicap. I also discuss hydrocephaly, I mention the complications but I also say that in our hospital we have a low, 2%, shunt infection rate. In essence, while not driven by any religious believe I am more positive than dry objective. I a aware of a study conducted by Mc. Lone in Chicago were he states that very few parents repent from having allowed the child to be born. In our hospital Dr. Bernard Churchill, a distinguished pediatric urologist who dedicated his skills to the well being of children with MMCL, advices cesarean section but we leave that decision to the obstetrician. I don’t recall receiving a call from an hospital were the child was born about how to care the wound. Every child has always arrived with the wound gently covered with a soft pad and already with IV ATB. I schedule the surgery as soon as possible without relining it. But if the surgery will be delayed 24 hours I act more forcefully, even if the child is well cared after at our state of the art neonatal unit.","thumbnailUrl":null,"publishDate":"2014-03-10T00:00:00.000Z","doi":"10.4103/2152-7806.128461","categories":["Pediatric Neurosurgery","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2015/05/4081/SNI-5-2.pdf"}