{"id":"5507fce8-040d-45b3-967c-b8c7140019c4","slug":"como-lo-hago-yo-tratamiento-quirurgico-del-mielomeningocele","title":"Como Lo Hago Yo: Tratamiento Quirurgico Del Mielomeningocele","authors":["Santiago Portillo"],"abstract":"En Argentina hay plan de fortificación con ácido fólico. Diagnostico prenatal no siempre es correcto. Cierre según técnica. Cerramos músculo. No favorecemos corpectomía temprana en casos de cifosis. Suturamos la plaqueta. Cerramos el plano muscular. Hidrocefalia: Válvula de derivación, generalmente dentro de los dos primeros meses. Ventriculostomía no está indicada. Chiari II. Laminectomia cervical alta. Siringomielia: Derivación desde la cavidad al peritoneo. While alpha-fetoprotein is indicative of an open neural tube defect, 40% of patients seen at our clinic in Argentina have had a diagnostic ultrasound. Majority of those patients had the study in the last trimester even on the week previous to delivery. Not always the child has the typical sac filled with fluid that simplifies the diagnosis while looking at an ultrasound, thus the incidence of smaller lesions and even flat lesions may account for the cases in which the parents were not aware of the condition of their child. In Argentina we have seen a decrease of the large thoracic lesions. This could be secondary to the implementation in 1993 of the law that mandates folic acid fortification of the flour. That in spite of this measure we still have cases suggests that physicians should be alerted on the value of recommending oral supplement of folic acid before pregnancy and also that not all the cases are necessarily related to folic acid deficit. Free the placode from the lateral adhesions. Be extremely careful when detaching the placode cephalically and caudally. To avoid damaging the normal cord and, caudally, to preserve the integrity of the cauda equina. Remove vestiges of dermal tissue to prevent growth of dermal cysts. Oppose the lips of the placode to restore the cylindrical shape of the cord Dissect, flap over and suture dura over the placode. Dissect and flap muscle fascia. There is controversy about this maneuver. I our experience there is no increased incidence of kyphosis or scoliosis and furthermore, our physical therapists have noticed that when manipulating the lumbar area in those children without a muscle layer over the dura plane it triggers involuntary movements. Adequate closure of skin. Release skin incision if necessary. We prefer “z” shaped. Always considering that a new surgery may be required for stabilizing the column. Explore the canal cephalically with the handle of a Penfield or similar small and round instrument for diastomatomyelia that could be repaired.","thumbnailUrl":null,"publishDate":"2014-03-10T00:00:00.000Z","doi":"10.4103/2152-7806.128465","categories":["Pediatric Neurosurgery","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/5507fce8-040d-45b3-967c-b8c7140019c4/pdf"}