Meningocele repair





Definition

A meningocele repair is a surgical procedure performed to repair an abnormal opening in the spinal column (called spina bifida) by draining excess fluid and closing the opening.


Purpose

The surgery is necessary to close this abnormal opening to decrease the risk of infection and protect the integrity of the spinal column and the tissue inside.


Demographics

According to the Spina Bifida Association of America, spina bifida is both the most common neural tube defect and the most common birth defect resulting in permanent disability. It is estimated that about 40% of Americans have spina bifida occulta. However, some people who have it may have no symptoms and may therefore be unaware of their condition, so the percentage is an approximation. Meningocele and myelomeningocele are noticeable at birth and are paired together as spina bifida manifesta. Spina bifida manifesta occurs in about one in 1,000 births, with 4–5% being meningocele and 95–96% being myelomeningocele.


Description

The term meningocele may be used to refer to more than one condition. Spina bifida is a neural tube birth defect involving an abnormal opening in the spine. It occurs when the fetus's spine does not close properly during the first month of fetal development. In spina bifida occulta an opening in the spinal bones exists, but the neural tissue and membrane covering the spine (the meninges) are not exposed. Because there is no opening, the defect may appear as a dimple, or depression, at the base of the spine (the sacrum). Another sign of spina bifida occulta is the presence of tufts of hair at the sacrum. It is possible that while there is no opening, vertebrae are missing and there is damage to nerve tissue.

A meningocele is a sac protruding from the spinal column, which contains some of the spinal fluid and meninges. The sac may be covered with skin or with the meninges, and does not contain neural tissue. It may be located near the brain or along the spinal column. Hydrocephalus is rarely present, and the neurological examination may be normal. Because the neural tissue remains intact, it can be repaired by the experienced neurosurgeon, with excellent results.

A myelomeningocele is the most severe type of spina bifida because the spinal cord has herniated into the protruding sac. Neural tissue and nerves may be exposed. About 80% of myelomeningoceles occur at the lower back, where the lumbar and sacral regions join. Some people refer to myelomeningocele as spina bifida. Because of the exposed neural tissue, significant symptoms may be present. These symptoms may include:

  • muscle weakness or paralysis in the hips and lower limbs
  • no sensation in the part of the body below the defect
  • lack of bowel and bladder function
  • fluid build-up in the brain, known as hydrocephalus

Because of the risk of neural tissue damage, swelling, and infection into the spinal fluid and brain with an opening in the spinal column, surgery to repair the meningocele or myelomeningocele is usually done within 24 hours of birth. However, although the opening is closed, whatever damage has already been done to the neural tissue is permanent. If hydrocephalus is developing, the meningocele repair may be done first. Then, a few days later, a shunt can be inserted to resolve the hydrocephalus. If the hydrocephalus is present at birth, the two surgeries may be done at the same time to decrease the risks associated with increasing pressure on the brain. To prevent drying of the sac, it may be kept moist with sterile dressings until surgery is begun. Once the anesthesia has put the baby to sleep and the surgery is pain-free, a surgical incision is made into the sac. Excess fluid is drained, and the meninges is wrapped around the spine to protect it. The opening is then closed with sutures.

Diagnosis/Preparation

If an individual has spina bifida occulta, with no outward signs of a neural tube defect and no symptoms, the condition may go undetected. The protruding sacs associated with meningocele and myelomeningocele are quite noticeable at birth. To understand the extent of the defect x rays, ultrasound, computed tomography (CT) scans, or magnetic resonance imaging (MRI) of the spine may be taken.

Spina bifida may be diagnosed while the mother is still pregnant, through prenatal screening. If spina bifida is indicated, a blood test will show an elevated alpha fetoprotein. However, elevated levels can be present without spina bifida, so further testing should be done if the test is positive. There is an elevated alpha fetoprotein level in about 85% of women with a fetus with spina bifida. An ultrasound can reliable reveal the spinal structure of the fetus. An amniocentesis may be done to check for chromosomal abnormalities. In amniocentesis, a long syringe is used to draw amniotic fluid out from the uterus through the mother's abdomen. Because the protruding sac of the meningocele and myelomeningocele can look the same on the outside, it is important to have a clear diagnosis, as the anticipated outcome of the two conditions is very different.


Aftercare

The infant will first spend some time in the recovery room , and then be transferred to an intensive care unit . The infant will be monitored for signs of excess bleeding and infection. Temperature will be closely monitored. Antibiotics will be given to decrease the risk of infection, and the infant will be positioned to lie flat on the stomach to avoid pressure on the surgical wound. Extreme care is taken to keep the wound clean of urine and stool.


Risks

Surgical risks include infection and bleeding. Anesthesia risks include a reaction to the medications used, including difficulty breathing. During meningocele and myelomeningocele repair, there are additional risks of damage to the spinal column and infection of the spinal fluid surrounding the spine and brain. Damage to the neural tissue could result in paralysis, or loss of nerve function (for example, loss of bowel and bladder control). There may also be an increased risk of an urinary tract infection. An infection of the meninges is called meningitis. However, further damage would be expected if surgery were not done, and serious infection would be likely. As in all surgery, one must weigh the potential risks against the expected benefits.


Normal results

Results depend greatly on the extent of involvement of exposed neural tissue and the condition of the infant prior to surgery. A meningocele repair can have excellent results, as neural tissue does not extend into the protruding sac. In myelomeningocele, the amount of exposed neural tissue will determine the extent of lower limb weakness, or paralysis. The infant will usually spend a few weeks in the hospital after surgery before being able to be discharged home. As the child grows, it may be necessary to use braces, crutches, or a wheelchair for mobility. If surgery for hydrocephalus is successful, the prognosis is better. Children with a repaired myelomeningocele may be able to go to school, but will benefit from special education and associated services. There may be varying degrees of learning problems, and difficulties with the child's attention span. An effective bowel and bladder-training program can help make attending school easier. Because of muscle weakness or paralysis, a child with spina bifida will need physical therapy and may require future surgeries.

Morbidity and mortality rates

With current medical and surgical treatments, about 85% of infants survive, and about 50% will be able to walk. Bowel and bladder disorders contribute significantly to morbidity and mortality in those with spina bifida who survive past the age of two years.


Alternatives

There is no alternative to surgical repair. Risk of infection and damage to the spine and brain is high with an opening to the spine, so surgery is necessary to close the opening and drain the excess fluid that could put pressure on the brain. The Spina Bifida Association of America recommends that all women of childbearing age take 0.4 mg of folic acid daily, as this amount has been shown to decrease the likelihood of neural tube defects. Once a woman is aware of being pregnant, the critical first month of neural tube development has already past, and folic acid cannot cure any damage that has been done.


Resources

BOOKS

Senisi, Ellen B. All Kinds of Friends, Even Green! Woodbine House, November 2002.


ORGANIZATIONS

March of Dimes Birth Defects Foundation. 1275 Mamaroneck Avenue; White Plains, NY. Telephone (914) 428-7100. http://wwwmodimes.org .

National Library of Medicine. http://www.nlm.nih.gov .

Spina Bifida Association of America. 4590 MacArthur Boulevard, NW, Suite 250; Washington, DC 20007-4226. Telephone (800) 621-3141, (202)944-3285. sbaa@sbaa.org. http://www.sbaa.org .


Esther Csapo Rastegari, R.N., B.S.N., Ed.M.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Surgery on the spine is a very delicate procedure and needs to be done by a surgeon specializing in pediatric neurosurgery . It is best performed in a hospital with a pediatric intensive care unit available to closely monitor the infant after the surgery.

QUESTIONS TO ASK THE DOCTOR


  • What is the extent of the neurological damage?
  • Is my child likely to walk?
  • What experience do you have with this procedure?
  • What complications have your patients experienced with this procedure?
  • How long is my child likely to stay in the hospital?

User Contributions:

sami sadiq
Report this comment as inappropriate
May 9, 2007 @ 3:03 am
you combined in the paragraph of risks the meninigocelle with myelomeningocele, while you say in the paragrah of normal results that a meningocele repair can have excellent results, as neural tissue does not extend into the protruding sac.
Please would you explain the difference here.
With Best Regards.
Sincerely
Sami Sadiq
Baghdad
Tarek Schinder
Report this comment as inappropriate
Jun 30, 2007 @ 5:05 am
Ten days ago(20-June), my wife gave birth to a twin, a boy and a girl. The girl was diagnosed with meningocele luboscrale in the 4th & 5th lumbars. All tests (IMR,X-ray and blood tests) were made, and on the 22nd of june, an operation "Meningocele Reconstruction" was made. Doctors here describes the operation as successfull.
But again, the IMR shows a big leteral ventriculum in her brain..
Please advise what should be done and what are the risks..?

Thank you and best regards,

Tarek Schinder
Indonesia
chetan patil
Report this comment as inappropriate
Dec 30, 2007 @ 8:08 am
My wife is pregnant.and after 23 weeks it has been detected that baby is having meningocele associated in lumbo-sacral region. should i go for Termination? 95% Doctors suggested me for termination. so please guide me.
Tawney
Report this comment as inappropriate
May 16, 2009 @ 3:15 pm
I have had bowel and blader problems for the last two months and they just did a ct scan and found that I have a sac or mass at the base of my spine, all I'm reading is about children, what about adult with this condition, is it seriouse? Just curiouse I'm seeing a neuro surgon on monday so I'll get my answers then I guess.
Glenda Tan
Report this comment as inappropriate
Dec 15, 2009 @ 11:23 pm
i have a niece born october 27, 2009 diagnosed with meningocele near her brain. the operation was successful and we keep hoping that hydrocephalus will not occur because we were alarmed after 2 days of operation fluid started to come out from the wound but it soon stopped after a day only. in the paragraph of risk, meningocele repair can have excellent result while myelomeningocele is complicated. does this mean that my niece will likely grow normal as other kids do? like she will be able to walk and see and hear and speak normally? please advise as this is so important to us her family and i am thankful i found your site.

best regards,
glenda tan
philippines
Appe Soriano
Report this comment as inappropriate
Nov 10, 2010 @ 2:02 am
I have an eight month daughter with a meningocele in the head and I'm not sure what kind of meningocele is that. Maybe you could help me to know it's kind and I also want to ask how dangerous is this illness and what are the proper ways of taking care a child with a meningocele. She is not yet operated. Thank you.
Report this comment as inappropriate
Dec 30, 2010 @ 1:01 am
A male boy was born 40 days back with myelomenincele with all clinical symptoms assosiated. Intially, Doc. have advised to undergo surgery, Shunt and orthopaedic treatments. We are still in confusion what to do further for the baby. We just would like to know what will be consequences if the child is not operated and shunted.
Report this comment as inappropriate
Mar 24, 2011 @ 6:06 am
My nephew was born on the 2nd of March 2011, he was 2 month premature. He dies and the doctors put Meningocoele as the cause of death. He sis not have a protrusion on his spine, it looked like part of his brain was out of his skull. The doctors told us there was no operation to repair this. I just wanted to know if that diagnosis was correct, as I now read that there are operations to repair Meningocoele. Any help at all would be greatly appreciated.
Report this comment as inappropriate
Oct 12, 2011 @ 8:08 am
Please help
I am residing in Swaziland and i need a doctors around Gauteng in RSA that specialises in meningitis. I would really appreciate your assistance.

Zanele
sam
Report this comment as inappropriate
Jan 15, 2012 @ 5:05 am
My sister is pregnant, its only yesterday that our doctor advice us for sonograph and it was found int he sonography as the baby has spina bifida in the lumbosacral region with a meningocele measuring 26 * 11 mm, doctors are recommeding for termination but we don't want to go for it, please suggest if any ways further, kindly guide as its bit urgent
Manu
Report this comment as inappropriate
Jan 19, 2012 @ 12:12 pm
Hi All,

I was born as meningocele and was operated at the age of 1 yrs. After the operation there was no control over urine and bowl. Then another operation at the age of 7 yrs. Now I am 44 yrs, single, managing everything of my own and still I have the same issue. It is very very difficult to lead such life in all respect. My parents don't want to lose me and no one in this world as a human-being would like to lose their child.

My friends, one should know how it is difficult, only when one go through that life.

Best Wishes and Regards.
harisini
Report this comment as inappropriate
Apr 19, 2012 @ 12:00 am
my sister was born with lumbar myelomeningocele in the spinal card lower limb operated soon after the birth. .now she is 5yrs old.in the MRI scan its showing L1-L5 introduced spinal card tumor.epidermoid with tethered card syndrome..doctors are advising to undergo surgery again...doctors are saying 95 percent chances are there to cure.but in some cases for the child brain fever can come that can sometimes leads to death..we are getting afraid and in confusion whether to undergo surgery or not...please guide us what to do as it is so important to my family..thank you
masum
Report this comment as inappropriate
May 8, 2012 @ 10:10 am
hello sir
My sis give birth to twin male child and only 1 suffer from myelomeningocoele
Child went for surgery and all is successfull. Now after surgery child kept in nicu for 5 days now ever thing is normal .but child both leg have less power ,child have feel in the both leg and can also move both leg. can u tell me mow to make child leg stronger and child life which treated for myelomeningocoele at birt time.plz reply
Afzal Tahir
Report this comment as inappropriate
Feb 7, 2013 @ 4:04 am
My daughter born on 24th September 2012 myelomeningocele. She was operated by Neurosurgeon on 20th December 2012 and myelomeningocele repaired by neurosurgeon. Another operation was made of V.P. Shunting for hydrocephalus.Shunt is functioning properly both wounds had been dried. She is feeding properly, Bowel and bladder normally working. but she is not moving legs. Prior to surgery there was slight movement in her legs. Kindly guide us how should we handle her and with the passage of time movement will come in her legs. Further there is also bend on her left foot. thanks

Islamabad
Pakistan
shyam gopal tiwari
Report this comment as inappropriate
Apr 5, 2013 @ 5:05 am
MY TWO DAY GHTER IS SUFFERING FROM MEININGOCELE SHOULD I OPERATE IT NOW OF AFTER 6 MONTHS CAN IT ALSO BE CURED FROM MEDICINE OR NOT
Report this comment as inappropriate
Apr 8, 2013 @ 3:03 am
My wife has 07 months Pregnancy,in Ultrasound it is Stated that "any fetal abnormality" Meningocele (Occipital) 3.7 * 3.0 cm,It is Curable or Not? Its side effect. Please Share? what should We do now?
George
Report this comment as inappropriate
Apr 8, 2013 @ 6:06 am
I see many questions about Myelomeningocele here. I am a Neurosurgeon and repaired about 180 cases over a 18 year period. Parents please understand that "the child can NOT move legs for ever if the nerves to the legs are NOT developed normally during the development. Also there is high chance that bowel bladder control will be lost. It's a burden for the family, and more importantly for the child itself.
Billions are spend in the USA treating complications associated with the life of this problem!
If have a new born with open myelomeningocele, I would let the child die from meningitis rather than let him or her suffer for years to come with no urine or feces control and paralyzed. Though some parents will not agree with this idea, it's MY personal choice in order NOT let the a child suffer due to a birth defect for entire life time. Many parents wants surgery and they get it!
saddia ahsan
Report this comment as inappropriate
Jun 17, 2013 @ 7:07 am
I HAVE 6 MONTHS PREGNANCY.THERE ARE CYSTIC AREAS AROUND THE NECK OF FETUS.LARGEST MEASURES 6.6 AND 5.8cm.IT IS COMMUNICATING WITH THE BRAIN STEM.CYSTIC AREAS OF ABOUT 2cm IS SEEN IN THE ANTERIOR SIDE OF NECK.AND SOFT TISSUE OEDEM,POSTERIOR TO THORACIC SPINE.WHAT IS YOUR OPINION ABOUT IT?should i go for surgery to abort it or can there be a normal delivery at this stage?PLZ REPLY SOON.
nina
Report this comment as inappropriate
Jul 15, 2013 @ 2:02 am
I am a 52 year old women and I have just been diagnosed with anterior sacrel myelomeningocele, ive been told this is a defect from birth which was not detected and through my life it has not been detected this has made me so mad, now I have the choice weather to have a life threatening operation to repair my spine or not have it that's like sitting on a time bomb waiting for it to burst then still have the operation done, the risks are meningitis, paralized,stroke, or I could die, what a choice I don't know what to do!
Report this comment as inappropriate
Dec 20, 2013 @ 8:08 am
I have baby girl of 24 days born with defect of occipital meningocele . Doctor has advised us to not to operate. What will be the life period of child if not operated? or what will be its consequences?
Pam
Report this comment as inappropriate
Jun 29, 2014 @ 9:09 am
I have a child who is 17 years old born with mylomeningocele (Spina Bifida) at the L-1, L-2 level. The doctors said he would not have much function but we didn't believe that. God is in control. Our son is in a wheelchair, however, he is very active. He has paralysis from the upper thighs down so does not walk at all. He is in the high school marching band, and several other clubs. He plays volleyball, basketball, and baseball. He is in the church youth group and is an honor roll student with plans to go on to college. Never, never give up on any child. Do your research and get the help they deserve. He is such a joy and inspiration to all who know him. I will be praying for all of you who are struggling.
Thulani
Report this comment as inappropriate
Jul 24, 2014 @ 1:13 pm
Please assist in recommending a specialist that can assist in repair of the protruding sac type, I am in RSA the Johannesburg area. Child is 1 day old.
jerico l. lizo
Report this comment as inappropriate
Aug 18, 2014 @ 2:02 am
please help me find a charity organization here in the Phil. my Daughter suffering for myelomeningocele she was borne In 8th day of August 2014

thank you and best regards
lauren
Report this comment as inappropriate
Aug 20, 2014 @ 8:20 pm
hello i have a 4 month old daughter who was diagnosed with a meningiocele. she was born with it she had a lot of tests and scans done. i was referred to shands in gainsville florida and the removed the protruding sac in the back of her head and she got a shunt put in. and she is fine. her surgery is fine she acts like herself. she moves all her limbs she can see and hear she's just like a normal baby with a possibility with a developmental delay. so to the parents out there with kids diagnosed with a meningiocele do not worry there is a way to fix it.
Ermias
Report this comment as inappropriate
Sep 15, 2014 @ 6:18 pm
I have four years & four months baby girl. She has done nerology surgery after birth with in three days. But when she grew up ,she can't control her stole & urine. We try to exercise & teach her, but no results.
She canot make sense.Frequently she infected her bladder & bladder tub. we get information from our Drs,the Urine flow back to kidney it can damage the kidney. So what kinds of medical treatment can we get? If there is medical treatment, please advise me.
Ermias Hailu
KEC
Report this comment as inappropriate
Oct 6, 2014 @ 4:04 am
I am 32 and a recent MRI showed myelomeningocele in the sacrum. I have an appointment with spinal surgeon soon to find out more. I suffer awful pain and also have degenerative disc disease. I'm wondering if it's linked?

Comment about this article, ask questions, or add new information about this topic:

CAPTCHA


Meningocele Repair forum