LONG-TERM FOLLOW-UP OF CHILDREN AND ADOLE SCENTS WITH MENINGOMYELOCELE - CONCEPT AND RESULTS OF AN INTERDISCIPLINARY COOPERATION

Background: Patients with meningomyelocele require treatment by variou s specialists, Findings based on an interdisciplinary concept of treat ing children with meningomyelocele are presented from neurosurgical, o rthopedic, urological and pediatric aspects. Methods: We report on 121 children and adolescents with meningomyelocele seen by a neurosurgeon , an orthopedist, an urologist and a pediatrician, Patients evaluated in this study were born between 1970 and 1989 (mean age 7.4 years). Re sults: Shunt implantations had been performed in 86.8% of the children . The mean number of shunt revisions was 1.6/patient, whereas shunt co mplications were seen most frequently during the first years of life. The intellectual development of the children was not significantly inf luenced by shunt complications (with appropriate therapy) - the rate o f mental retardation was significantly higher in the group of patients with epilepsy, microcephaly or chromosomal anomalies. 50.6% of the ch ildren were ambulators, 23.5% without any support. A high number of sk eletal malformations was found: feet deformities (83.5%), scoliosis (3 4.4%), hip dislocations (24.0%), contractures of the hip joints (35.5% ) and knee joints (43.0%). As to the urological aspect the upper renal tract and bladder continence were studied. Vesico-ureteral reflux occ urred in 46 children (39.2%). During the past two years 78% of the pat ients had symptomatic urinary tract infections (mean 1.8/year). Social ly continent (dry greater than or equal to 2 hours) were 20.9% of the children, entirely continent were 7.4%. Certain therapeutic procedures (clean intermittent catheterization, anticholinergic therapy) have be en used and appear to have a positive influence to the continence and the urological prognosis (upper renal tract) of children with meningom yelocele. Conclusions: Following an interdisciplinary concept for the treatment of children with meningomyelocele their quality of life and life expectancy were greatly enhanced, Interdisciplinary follow-up pro grams are also necessary for adult patients with meningomyelocele.