الفهرس Only 14 pages are availabe for public view
 |  | from | 114 |  |  |
| | | from | 114 | | |
Abstract
Spinal dysraphism is a group of congenital anomalies involving the spinal cord and the vertebral column. Spinal dysraphism is classified into two main groups, open spinal dysraphism and closed spinal dysraphism.
The closed spinal dysraphism refers to any congenital spinal dysraphism with intact skin. The open spinal dysraphism include mainly meningocele and meningomyelocele, myeloschitis in which the neural structures are not covered by skin.
The diagnosis of spinal dysraphism can be done by. Prenatal diagnosis using serum alpha fetoprotein level, and prenatal ultrasonography, prenatal MRI.
Post natal diagnosis is done by clinical examination, plain radiography magnetic resonance imaging and it is the study of choice as it shows all the lesion details beside it shows the tethering element. Computerized tomography, electrophysiological study.
The treatment of spinal dysraphism included surgical repair of the defect after adequate detethering of the neural structures putting in consideration the CSF diversion in cases associated with hydrocephalus and posterior fossa craniectomy and upper cervical laminectomy in (Chiari malformations).
The recent modalities in treatment is the intrauterine repair of myelomeningocele and the intrauterine CSF diversion but these procedures carry the risk of increasing morbidity and mortality for both mother and foetus despite it showed good results regarding the neurological function.
The use of folic acid by mothers during the periconceptual period have decreased the neural tube defects.
Our study was conducted over 40 patients, 20 patients presented to the Main Alexandria University Hospital and 20 presented to the armed forces hospital in saudi Arabia.
All the patients were subjected to clinical examination and investigation according to each case. The age of the patients ranged from zero day to 50 years.
The surgical procedures done were myelomeningocele repair in 16 cases, meningocele repair in 8 cases, lipomyelomeningocele in 4 cases, tight filum terminal resection in 4 cases, diastematomyelia septum resection in two cases, posterior fossa decompression and duraplasty in 2 cases, spinal cord lipoma resection in 2 cases, C.S.F. diversion in 6 cases.
The results of this study four out of 13 paraparetic patients showed motor improvement, the sphincteric disturbance preoperatively was 25 incontinent and 15 continent, post operatively it was 21 continent and 19 incontinent from this study we found that the use of folic acid by mothers reduce the incidence of spinal dysraphism and the early surgical detethering decrease and prevent the neurological deficit in spinal dysraphism.