[Neurosurgical treatment of spinal dysraphism in children].

A tethered cord syndrome includes in its meaning all types of dysraphism in children. The syndrome is described in regard to its etiology, pathophysiology and clinical outcome. Next, the most prevalent types of dysraphism in children are presented. A surgical approach in myelocele--the most frequent defect--is discussed in detail. Reasons for taking a difficult decision not to operate are considered. The most important operative problems are also reviewed. It is reminded that myelocele often coexists with Arnold-Chiari malformation type II and hydrocephalus. Problems in selecting an appropriate surgical approach in this syndrome are shortly discussed. A rare syndrome of sacral agenesis, poorly amenable to surgical intervention, is presented. There are also some less frequent syndromes described, including:-sinus dermalis, potentially life-threatening in the case of recurrent meningitis;-lipomyelocele, needing early identification and prophylactic surgical treatment;-diastematomyelia, in half of the cases requiring surgery due to a bony spur;-retethered cord syndrome, an iatrogenic complication of neurosurgical interventions done on the spinal cord.