In this manner, one may better understand

the child’s neurosurgical condition at #find protocol randurls[1|1|,|CHEM1|]# a particular point in time. Myelomeningocele Myelomeningocele is the most common dysraphic malformation and occurs in approximately 1 in 1200 to 1400 births.35 Myelomeningocele derives from a failure of the neural tube to close or a secondary Inhibitors,research,lifescience,medical reopening of the closed neural tube.36 The term myelomeningocele is used to describe open spinal dysraphism. There is no such thing as closed myelomeningocele. It can occur at any level of the spinal cord and is the most severe form of dysraphism. The majority of children (80%) with isolated myelomeningocele have normal intelligence, although 60% have some learning disability. The life expectancy of these children is nearly normal.37 Most of these children (60%) are community ambulators, and 80% are socially Inhibitors,research,lifescience,medical continent (dry), although many of them receive clean intermittent catheterization.38 Myelomeningocele is a static disease; any deterioration in these children must be examined carefully, and a clinical evaluation and imaging study should be done promptly. The most common cause of deterioration is shunt malfunction. Other causes are tethered cord, Chiari Inhibitors,research,lifescience,medical malformation, and syringomyelia.

The most frequent symptoms of deterioration are headache, nausea, vomiting, behavior modification, and change in upper or lower extremity strength and coordination. The Inhibitors,research,lifescience,medical urologist must be aware and pay close attention to modifications in urinary function and bowel habits. Frequently a change in bladder function detected in routine urodynamic study may lead to diagnosis of a tethered cord. Occult Spinal Dysraphism Occult spinal dysraphias are closed forms of spinal Inhibitors,research,lifescience,medical dysraphism in which the skin covers the neural tissue. They occur most often at S1, S2, or both.39 Although some of these spinal dysraphic lesions are truly occult, in most a skin marker is present (hairy patch, cutaneous

nevus, an appendage or skin tag, small dimple with a pinhole, lipoma).40 Recognizing these cutaneous marks is important because they are usually Vasopressin Receptor associated with some form of dysraphism that can cause spinal cord injury and lead to progressive and sometimes sudden neurologic deterioration (Table 3). Stabilization of the lesion may be achieved by untethering the cord, but neurologic, urologic, and orthopedic problems are often irreversible when they occur.37 Therefore, most pediatric neurosurgeons prefer to correct these malformations prophylactically, before the onset of symptoms. Table 3 Skin Stigmata of Occult Spinal Dysraphism Occult spinal dysraphias may be of many different embryologic etiologies, but they are usually associated with tethering of the spinal cord.