Preparation for Surgery for Occult Spina Bifida Occulta and Tethered Cord Syndrome in Children

Indications for Procedure

  • Weakness: Motor weakness is present in the lower extremities.
  • Gait deterioration: Worsening gait abnormalities and difficulty walking occur.
  • Loss sensation: There is impairment of lower extremity sensation or saddle anesthesia.
  • Pain: Intractable back pain is present.
  • Deteriorating urological function: Worsening impairment of bladder function is apparent.

Preoperative Orders

  • Routine

Anesthetic Considerations

  • Positioning: Particular attention should be paid to the pressure points such as the chin and eyes during surgical positioning.
  • Blood pressure: Hypotension must be prevented.

Devices to be Implanted

  • Dural sealant: Fibrin glue or blue glue should be available for sealant of the dural closure.

Ancillary/Specialized Equipment

  • Intraoperative monitoring: Motor and sensory evoked potentials as well as free-running EMG can used.
  • Microscope: The surgical microscope may be used. However, surgical loupe magnification is often sufficient.
  • Localizing plain radiographs: MRI or CT may be useful, particularly if a split cord is present.