Long-term Follow-up Results of Infants with Myelomeningocele

One hundred and twenty-four infants with open myelomeningocele who were treated at the Central Hospital, Aichi Prefectural Colony, between Oct. 1969 and Mar. 1988 were analyzed retrospectively for the long-term follow-up results. Of these 120 (97%) unselected infants received back closure operation, and 98 (79%) neonates had early surgery within the first 48 hours of life. Hydrocephalus was recognized in 106 (85%) cases and shunt operation was performed on 91 (73%) infants. Thirty-one (25%) infants died, and of these 27 cases died before 3 years of age. Eight were lost in the follow-up period, and the remaining 85 survived. Of these 61 children had been followed for more than 6 years, and were able to be school children in Apr. 1988. Thirty-nine (64%) children entered the ordinary school and the remaining 22 children attended the special school. Intelligence quotient (IQ) was assessed by Binet test (Japanese version by Tanaka) in 51 school children. Seventy-three percent of 51 children, 91% of 33 ordinary school children and 39% of 18 special school children maintained IQ above 80. The grade of neonatal hydrocephalus correlated with later intellectual development (Table), but several children with severe ventriculomegaly had IQ above 80 being accepted to the ordinary school. Of 49 hydrocephalic children with shunt, 27 (55%) children entered the ordinary school. Poor intellectual development may be related with such congenital anomalies in central nervous system as Chiari type II malformation and other cerebral malformations. In thirty-eight (69%) of 55 children without ventriculitis, level of paralysis was between the L4 (intact L4) and the SI (intact SI).