Selection for Early Treatment in Myelomeningocele: A Retrospective Analysis of Various Selection Procedures

Abstract

The results of early surgical treatment in 163 children with open myelomeningocele 1963-1968 were reviewed. Based upon this review, a selection protocol is proposed. Lacunar skull deformity (LSD, lückenschädel), a common x-ray finding in newborns with myelomeningocele, is quite strongly associated with eventual mental retardation. Early surgery is not recommended for children having both LSD and multiple adverse physical findings or those with associated gross congenital anomalies. The proposed protocol is shown to be of considerably greater reliability in predicting outcome among our cases than existing selection criteria.