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《Journal of Harbin Medical University》 2002-01
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Pathological classification and microsurgical treatment for the myelomeningocele

ZHANG Qi tao,HAN Fu you,GUAN Sheng yang, et al (Department of Pediatric Surgery,The Second Clinical College,Harbin Medical University,Harbin 150086,China)  
Objective To further understand the pathological characteristics,present a clinical classification and select the proper management for myelomeningocele.Methods 25 cases of myelomeningocele were reviewed and a new classification was proposed on the basis of operative findings.They are typeⅠ:simple nerve adherence;type Ⅱ:medullary plate terminale;type Ⅲ:lipomyelomeningocele;type Ⅳ:tethered cord dominant.Cauda equina nerves were released carefully and the non functional nerves were removed for typeⅠ and Ⅱ under microscope.The lipoma in type Ⅲ was sectioned properly and the enlarged filum terminale fiber resection was performed with full release of all nerves.Results 22 patients were followed up through 1~6 years.The effective rate was 89%(14/16) in type Ⅰ and Ⅱ,66%(4/6) in type Ⅲ.The 4 patients with spinal lipoma in type Ⅳ showed no improvement in urination and bowel movement and ambulatory function.Otherwise the result for the patients without spinal lipoma was good.The total satisfactory rate was 71%.Conclusion The classification of myelomeningocele is helpful in the procedure selection and correct evaluation of prognosis.MRI examination before operation and microsurgical technique application are important to get a good result in the follow up.
【CateGory Index】: R726.5
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