Two Surgically Treated Neonatal Infants with Open Myelomeningocele and Associated Congenital Intrathoracic Cyst
The policy of surgical treatment in infants with open myelomeningocele is now controversial. Criticisms against the selective operation for myelomeningocele, proposed by Lorber and Stein, have been reported and the decision making process for treatment has become more complex in recent years. Generally, aggressive treatments for myelomeningocele are not recommended in neonatal infants associated with severe asphyxia, severe intracranial hemorrhage, fetal infections or irremediable systemic anomalies. But the decision to treat or not treat infants with myelomeningocele and remediable systemic anomalies other than the central nervous system is debatable. The authors treated aggressively two neonatal infants with myelomeningocele and associated congenital intrathoracic cysts. Both of these infants had thoraco-lumbar myelomeningocele and a congenital pulmonary cyst or neurenteric cyst. Myelomeningocele in both infants were repaired within 3 days after birth and the congenital intrathoracic cysts were also extirpated. Both were followed-up for 2 years after the surgery and showed subnormal development except for the total dysfunction of the lower extremities and bladder at the end of the follow-up period. The author concluded that the decision making in the treatment of infants wth myelomeningocele and accompanying systemic anomalies other than CNS is principally based on whether these systemic anomalies are remediable or not, and what the likely outcome in these infants is.