Article written by Great Ormond Street Hospital Myelomeningocele
Myelomeningocele is a type of spina bifida. This is when the neural tube has failed to close and the neural tissue is exposed on the baby’s back. The myelomeningocele will look like a sac sticking out from a baby’s back.
In early development, the brain and spinal cord start as a tube-like structure called the ‘neural tube’ that is open at either end. These openings close within the first weeks of pregnancy, and the neural tube continues to grow and fold, eventually forming the brain and spinal cord.
If the tube fails to close properly, this results in a group of problems called ‘neural tube defects’. There are two types of neural tube defect: open, also called spina bifida aperta or myelomeningocele, or closed, also called spina bifida occulta.
This information explains about the open myelomeningocele type, which accounts for 75 per cent of all cases of spina bifida.
In myelomeningocele, the neural tube has failed to close and the neural tissue is exposed at a place on the baby’s back called the ‘neural placode’. This most commonly happens in the baby’s lower back just above the bottom, but could occur anywhere along the spine. The myelomeningocele will look like a sac sticking out from the baby’s back.
How is myelomeningocele treated?
Without the protective covering of skin, the spinal cord will become further damaged, spinal fluid often leaks from the area and there is a very high risk of infection. Surgery is usually recommended within the first few days of life.
The aim of surgery at this stage is to put the spinal cord back into the spinal canal and repair the defect in the back so that the area is covered with normal, healthy skin.
Before surgery, the affected area is covered with a dressing and the baby will be nursed on their front. A number of specialists will visit to examine the baby, including a neurosurgeon, physiotherapist, paediatrician, orthopaedic surgeon and anaesthetist.
After the operation, the infant will be nursed on our neurosurgical ward, still on their front for most of the time, although parents will be able to feed their baby by breast or bottle and pick up the child as normal.
The physiotherapist will see the child after the operation. They will assess how much strength the baby has in each muscle group and measure their sense of feel. When taken together, muscle strength, sensation and reflexes give us a picture of how well the messages are getting from the brain to the arms and legs via the spinal cord.
The physiotherapist will also give advice on how to position and handle the child to stretch out tight muscles and to help with normal development. They may also refer a child to local physiotherapy services who can continue to see the child and monitor their development. They will also monitor the movement in the child’s muscles and joints and may refer them to an orthopaedic doctor at a local hospital.
Once the baby is recovering well, they will be able to go home. We will need them to come back to the ward between 10 and 14 days after the operation, so that we can check the operation site, carry out an ultrasound scan of the baby’s head and measure their head circumference.
Four to six weeks afterwards, they will need to come to clinic for a further check up appointment. <!-- Global site tag (gtag.js) - Google Analytics -->
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