Type of Surgery
Last updated: 02/17/2009
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.
Meningocele repair is surgery to repair birth defects of the spine and spinal membranes. . For both meningoceles and myelomeningoceles, surgery consists of putting the spinal cord or nerve roots in their normal place and protecting them by closing the overlying meninges and skin.
A myelomeningocele should be closed within 24 hours of birth to prevent infection. A shunt is usually required to drain excess fluid. If the baby has fluid build-up in the brain, a shunt is usually put in when the myelomeningocele is repaired. Otherwise, most neurosurgeons wait about 3 days to place a shunt.
If hydrocephalus is present at birth and already causing problems, then the myelomeningocele repair and shunt are done at the same time.
After surgery, antibiotics are usually given to prevent infection.
Select comparative data from 1999 to 2006 include a decrease of 14 percent in the number of neurosurgeons in private practice and a decrease of 13 percent in the number of neurosurgeons in solo practice.
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