The Shortsighted Treatment of Myelomeningocele: A Long-Term Case Report

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Abstract
Meningomyelocele is the most common severe congenital anomaly of the central nervous system (CNS), occurring in approximately 1/1,000 births. Until the late 1950s nothing was done for these children. Ingraham wrote that they should be given routine care until 18 months of age, when an accurate assessment of their neurologic function and intelligence could be made before closing the back. Many-most-died. The survivors who had severe hydrocephalus, hydronephrosis, and marked paraplegia, were left untreated at home or in institutions. The few survivors who did well were often children with meningoceles whose backs were then closed at 18 months. Studies from England suggest that 10% to 16% of children with meningomyelocele who are untreated are alive at 1 to 2 years, and at least 7% of the most severely affected survive to one year. If a child lives two months, he has a 28% chance of being alive at 11 years-untreated. With vigorous, early treatment he has a 50% to 80% chance of survival and, depending on the series, has a poor chance for a useful, productive life or a good chance for being "competitive." How then should we approach the newborn with a meningomyelocele? What should be our approach to his or her management? This case report is intended to emphasize the disastrous potential results of one common form of management. CASE REPORT An 8-year-old white boy was recently brought to the Birth Defects Treatment Center for recommendations about future care. He was the third child of middle class parents and was born and treated elsewhere.

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