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Meningocele repair
Definition
Meningocele repair (also known as myelomeningocele repair) is surgery to repair birth defects of the spine and spinal membranes. Meningocele and myelomeningocele are types of spina bifida.
Alternative Names
Myelomeningocele repair; Myelomeningocele closure; Myelodysplasia repair; Spinal dysraphism repair; Meningomyelocele repair; Neural tube defect repair; Spina bifida repair
Description
For both meningoceles and myelomeningoceles, the surgeon will close the opening in the back.
After birth, the defect is covered by a sterile dressing. Your child may then be transferred to a neonatal intensive care unit (NICU) and cared for by a medical team experienced in caring for children with spina bifida.
Your baby will likely have an MRI (magnetic resonance imagining) or ultrasound of the back. An MRI or ultrasound of the brain may be done to look for hydrocephalus (extra fluid in the brain).
If the myelomeningocele is not covered by skin or a membrane when your child is born, surgery will happen within 24 to 48 hours after birth to prevent infection.
If your child has hydrocephalus, the doctor may put a shunt (plastic tube) in their brain to drain the extra fluid to the stomach. This prevents pressure that could damage the baby’s brain. See also: Ventriculoperitoneal shunt
Your child should not be exposed to latex before, during, and after surgery. Many of these children have very bad allergies to latex.
Why the Procedure Is Performed
Repair of a meningocele or myelomeningocele is needed to prevent infection and further injury to the child’s spinal cord and nerves. Surgery cannot correct the defects in the spinal cord or nerves.
Risks
Risks for any anesthesia are:
- Breathing problems
- Reactions to medications
Risks for any surgery are:
- Bleeding
- Infection
Risks for this surgery are:
- Fluid build up and pressure in the brain (hydrocephalus)
- Increased chance of urinary tract infection and bowel problems
- Infection or inflammation of the spinal cord
- Paralysis, weakness, or sensation changes due to loss of nerve function
Before the Procedure
A health care provider often will find these defects before birth using fetal ultrasound. The doctor will follow the fetus very closely until birth. It is better if you're infant is carried to full term. Your doctor will want to do a cesarean section (C-section). This will prevent further damage to the sac or exposed spinal tissue.
After the Procedure
Your child will usually need to spend about 2 weeks in the hospital after surgery. The child must lay flat without touching the wound area. After surgery, your child will receive antibiotics to prevent infection.
MRI or ultrasound of the brain is repeated after surgery to see if hydrocephalus develops once the defect in the back is repaired.
Your child may need physical, occupational, and speech therapy. Many children with these problems have gross (large) and fine (small) motor disabilities, and swallowing problems, early in life.
The child may need to see a team of medical experts in spina bifida often after they are discharged from the hospital.
Outlook (Prognosis)
How well a child does depends on the initial condition of their spinal cord and nerves. After a meningocele repair, children often do very well and have no further brain, nerve, or muscle problems.
Children born with myelomeningocele usually have paralysis or weakness of the muscles below the level of their spine where the defect is. They also may not be able to control their bladder or bowels. They will likely need medical and educational support for many years.
The ability to walk and control bowel and bladder function depends where the birth defect was on the spine. Defects lower down on the spinal cord may have a better outcome.
References
Kinsman SL, Johnston MV. Congenital anomalies of the central nervous system. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 592.
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
