Pediatric Orthopedic Surgeons treating Meningomyelocele

MENINGOMYELOCELE

 

When people talk about spina bifida, they are usually referring to Meningomyelocele, which is the most serious type of spina bifida. With this condition, a sac of fluid comes through an opening in the baby’s back. Part of the spinal cord and nerves are in this sac and are damaged

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Meningomyelocele in Newborns

Spina bifida is a birth defect that includes meningomyelocele, also called myelomeningocele. Spina bifida appears as a birth condition when the baby’s spinal canal and backbone do not fully shut before birth. The term “neural tube defect” also applies to this kind of birth abnormality. The meninges, the tissue that surrounds the spinal cord, and the spinal cord itself may protrude through the child’s back. Sometimes, the skin on the child’s back will cover the spinal cord and its meninges. The meninges and spinal cord may also poke through the skin in other situations. The following identify the three most common types of spina bifida:

  • Spina bifida occulta
  • Meningocele
  • Meningomyelocele (myelomeningocele)

Meningomyelocele is the most serious of all three. The most prevalent and mildest kind is spina bifida occulta.

The Signs and Symptoms of Meningomyelocele

The spinal cord appears visible at birth in a newborn with meningomyelocele. A sac covering an exposed spinal cord appears on the mid to lower back. The child’s unique condition will determine the precise symptoms and their intensity. Because the brain and spinal cord are typically impacted and the condition is frequently quite severe with meningomyelocele, leg, bladder, and bowel dysfunction usually occur. In some children, the ability of a very skilled doctor to regulate the bladder or bowels may not be possible. In addition, some children might have sensory loss or partial or total paralysis in their legs; yet in other children, these functions appear only slightly impaired. Other potential symptoms include:

  1. Orthopedic deformities
  2. Hydrocephalus (an accumulation of fluid in the skull that causes brain swelling)
  3. Chiari malformation (anatomical flaws in the brain region responsible for maintaining balance)

A kid with meningomyelocele runs the risk of getting bacterial meningitis because of the spinal cord’s exposure to the environment.

What Causes Meningomyelocele?

Doctors and scientists have not been able to find a cause for this condition.  One theory proposes that folic acid deficiency during and throughout early pregnancy hinders spinal cord development. The illness might potentially conclude a hereditary component; however, thus far evidence does not support this theory.

Diagnosis

The majority of Meningomyelocele diagnoses occur in utero. The maternal serum alpha-fetoprotein (MSAFP) test may hint at the diagnosis. This typical test finds alpha-fetoprotein, a fetus protein, in the mother’s blood. Because alpha-fetoprotein normally remains in the developing fetus, it can indicate problems such as open neural tube defects when present in the maternal blood. However, the MSAFP does not always provide accurate results. It can provide both false positives and false negatives.

If MSAFP returns anomalous results, it usually requires further testing. At this point, an imaging scan such as high-resolution ultrasound often provides a definitive diagnosis. Ultrasound, a common and safe procedure for prenatal care, uses high-frequency sound waves to create images of internal structures. Meningomyelocele is often not diagnosed until birth when it is clearly visible and easily diagnosed in newborns.

Risk Factors

Doctors and scientists believe that Meningomyelocele has several causes. Early in development, maternal folate deficiency (a nutrient present in beans, citrus, leafy green vegetables, and fortified grain products) frequently exists in mothers who give birth to infants with Spina Bifida; however, it has been determined that this deficiency cannot independently cause the condition. Prenatal environmental factors, such as maternal diabetes, obesity, or high body temperature, may affect how the illness develops as well.

Treatments

In order to lessen the possibility of infection or further spinal cord damage, newborns with Meningomyelocele can get surgically treated in utero. Although it is not always possible and includes risks for both mother and fetus, the operation has generally shown encouraging outcomes. Normally and in the majority of cases, treatment of the infant will occur during the first three days of life when a pediatric neurosurgeon will close the spine and the back. Our doctors will order imaging to identify other potential anomalies that the surgeon might treat during the operation.

The baby will lay face-down throughout the procedure. Our pediatric neurosurgeon will meticulously remove tissue — layer by layer — while using a surgical microscope and extremely intricate equipment. The surgeon preserves the spinal cord, eliminates as many potentially dangerous components as he can, and restores as much of the spinal column’s natural structure as he can.

Following surgery, a gauze bandage covers the wound for a few days. The baby can be carried on the stomach for eating, breastfeeding, therapy, and “skin-to-skin” time with parents, but may need to rest face-down or on his or her side in the bassinet.  Meningomyelocele unfortunately does not become “cured” by surgery. A spinal cord that did not grow correctly or is not present at birth cannot be functionally restored via surgery. Numerous neurological issues occur with Meningomyelocele-affected children, and certain difficulties call for ongoing treatment and observation.

After Surgery

A child with Meningomyelocele will benefit greatly from regular follow-up with our team of medical professionals that includes a pediatric urologist, orthopedist, neurologist, and physical therapist in addition to a pediatric neurosurgeon. A pediatric neurosurgeon evaluates each child’s unique circumstance and develops a treatment plan in collaboration with the family. Our pediatric neurosurgeons not only repair the newborn’s open spinal deformity but also diagnose and manage the following neurological disorders that occur in conjunction with Meningomyelocele:

Hydrocephalus:

Doctors refer to a buildup of liquid within the brain as Hydrocephalus. This condition appears in roughly 80-90% of children with Meningomyelocele. Our doctors treat this with a shunt — a lean tube that a neurosurgeon inserts within the body to deplete absent the abundance of liquid. Lately, a few cases were treated effectively with an endoscopic third ventriculostomy and choroid plexus cauterization to avoid the requirement for a shunt. Hydrocephalus is ordinarily treated sometime recently after an infant’s release from the healing center.

Chiari Malformation

The disease known as Chiari malformation refers to when the base of the skull is too tiny to accommodate the brain. A Chiari malformation results in some brain tissue being pushed down out of the skull and into the spinal canal (Chiari malformation can have multiple origins; One II is the type present at birth, like in spina bifida). The signs of a Chiari malformation do not always appear.  There is no need for treatment if it has no symptoms. Doctors will recommend Surgery when it results in progressive symptoms or symptoms that worsen with time. Chiari malformations can manifest as frequent aspirations (breathing in food or saliva), apneas (pauses in breathing), neck aches, and arm paralysis. Families and caregivers might benefit from guidance from a pediatric neurosurgeon in recognizing signs of Chiari malformation in a baby or young kid.

Tethered Cord:

Tethered Cord (TC) is a disorder in which the spinal cord is “stuck” to a structure within the spine such as dura, scar tissue from a previous operation, a bony spicule, or even a tumor. This condition causes a constraint on the spinal cord’s range of motion. Doctors know that developing children with Spina Bifida can have this problem and will continue to observe the spine’s flexibility. When it manifests symptoms, our doctors will carefully examine each child’s condition, and then will recommend either surgery or close observation. In addition to helping families and caregivers understand how to keep an eye on the child’s growth at home, our doctors will continue to observe the child’s neurological function during office visits.

The Long-Term Outlook

People with spina bifida now live longer thanks to modern therapies. According to the University of Northern Carolina, 90% of those with this illness survive until maturity. The treatments for spina bifida get better all the time. Spina bifida babies frequently need several surgeries to correct the physical deformities that they are born with. In the first few years following diagnosis, babies will likely pass away as a result of a birth defect or a complication from surgery to cure a birth defect.

How can I Prevent Meningomyelocele?

Low folic acid levels are associated with spina bifida and other neural tube abnormalities. During pregnancy, it’s critical to take folic acid supplements. Especially during pregnancy, the B vitamin folic acid helps the growth of red blood cells and for overall health. Prior to being pregnant, our doctors recommend taking folic acid supplements.

Call 214-556-0590 to make an appointment.

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