{"id":"84f6645d-c7c7-444e-85be-6f7dfd5a0511","slug":"how-i-do-it-management-of-spina-bifida-in-a-hospital-in-the-peoples-republic-of-china","title":"How I Do It: Management of spina bifida in a hospital in The People’s Republic of China","authors":["Nan Bao","Jorge Lazareff"],"abstract":"We present our personal experience on patients with Spina Bifida. It is the result of having treated 1600 children for 12 years at Shanghai Children's Medical Center. We classify the cases on Spina Bifida Manifesta (myelomeningocele, myelocele, lypomyelomeningocele) or Spina Bifida Oculta (lipoma, dermal sinus and thickened filum terminale). For the former, we recommend surgery within 24–48 h after birth. For the latter we recommend preventive surgery months after birth. We acknowledge that the diameter of the spinal canal is a problem for large remnant lesions. In cases of myelomeningocele, we prefer to place the shunt and close the defect in the same procedure, it reduces the risks inherent to exposure to anesthesia, reduces hospital stay, and related costs. If there is a suspicious of infection, we do not place the shunt on the same procedure. The personal description of the preferred techniques for closure of the different defects is described. There are several types of neural tube defects and each type can be divided into various subtypes. According to our experience in the treatment of nearly 1600 patients with different types of neural tube defects at the Neurosurgery Department of Shanghai Children's Medical Center over the past 12 years, we divided common neural tube defects into the following types: This type can be further divided into the following subtypes according to the pathological morphology: Patients with this subtype of neural tube defect have a mass on their back. The surface of the mass is a thin cyst wall and in some cases there is no skin [ Figure 1 ]. In other cases, the mass is covered by skin but the color is blue; there is no subcutaneous fat tissue, and the dermis shows scar-like degeneration and adheres directly to the cyst wall [ Figure 2 ]. The cyst wall is composed of the dura mater, arachnoid mater, pia mater, and deformed spinal cord, which protrudes outside the skin via the spinal defect. According to differences in the diseased segments and morphologies of spinal cord herniation, this subtype can be further divided into two subtypes. Type I is a herniation of the end of the spinal cord, in which the herniated spinal cord terminates at the roof of the bulging dura mater. It is commonly seen in the lumbosacral and sacral segments [Figures 1 and 2 ]. Type II is an omega-shaped (Ω-shaped) herniation of the spinal cord, in which the middle part of the herniated spinal cord makes up the roof of the bulging dura mater, but the end of the spinal cord is located in the distal spinal canal. This type is commonly seen in the lumbar and thoracolumbar segments [ Figure 3 ].","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/84f6645d-c7c7-444e-85be-6f7dfd5a0511/featured/hero-1782420968492.png","publishDate":"2015-07-23T00:00:00.000Z","doi":"10.4103/2152-7806.161410","categories":["Pediatric Neurosurgery","Original Article"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2015/07/6168/SNI-6-337.pdf"}