Myelomeningocele

About Myelomeningocele

General Information

• A myelomeningocele is a birth defect in the vertebral arches of the spinal column with a cystic protrusion of the meninges (the membranes covering the spine) and neural tissue.
• The incidence of spina bifida, or failure of the spine to close, with meningocele or myelomeningocele is up to 2 per 1,000 live births. The risk increases to 2 percent to 3 percent if a couple has one previous birth with myelomeningocele and 6 percent to 8 percent after two affected children.
• Hydrocephalus develops in 65 percent to 85 percent of patients with myelomeningocele, and 5 percent to 10 percent of patients have obvious hydrocephalus at birth.
• Other late problems associated with myelomeningocele are syringomyelia and tethered cord.
• Most myelomeningocele patients will have an associated Chiari type 2 malformation.

Treatment

• Myelomeningoceles need to be closed with 24 hours. Extreme care is taken during the procedure to protect exposed neural tissue and place it into as normal a location as possible. Finally the overlying layers need to be closed in a watertight fashion.
• The assistance of a plastic surgeon may be necessary to close large defects.

Outcome

• Early closure of the defect is not associated with improvement of neurological function, but is associated with a lower infection rate.
• Without any treatment only 14 percent to 30 percent of myelomeningocele infants survive infancy, and 70 percent will have normal IQs and 50 percent will be ambulatory.
• With modern treatment approximately 85 percent of infants survive, and 80 percent will have normal IQ. Between 40 percent and 85 percent will be ambulatory with bracing, and 3 percent to 10 percent will have normal urinary control.

The Neuro-ICU cares for patients with all types of neurosurgical and neurological injuries, including stroke, brain hemorrhage, trauma and tumors. We work in close cooperation with your surgeon or medical doctor with whom you have had initial contact. Together with the surgeon or medical doctor, the Neuro-ICU attending physician and team members direct your family member's care while in the ICU. The Neuro-ICU team consists of the bedside nurses, nurse practitioners, physicians in specialty training (Fellows) and attending physicians. UCLA Neuro ICU Family Guide