Meningocele repairDefinition: A meningocele is when the meninges (membranes that cover the spinal cord and brain) and cerebrospinal fluid bulge beneath the skin. Meningocele repair is surgery to drain the cerebrospinal fluid and repair birth defects of the spine and spinal membranes. It is used to treat the conditions listed below: - Spina bifida: a birth defect involving an abnormal opening of the spinal area.
- Spina bifida occulta: a common abnormality of spinal bones that usually does not have symptoms, but is sometimes associated with conditions that can require surgery.
- Meningocele: a birth defect in the bones of the spine that involves a swelling in the meninges, but no abnormality of the spinal cord or nerve roots.
- Myelomeningocele : a birth defect in the bones of the spine with swelling of the meninges and abnormality of the spinal cord or nerve roots.
Alternative Names: Spina bifida repair; Myelomeningocele repair; Myelomeningocele closure
Description: 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.
Indications: Surgery is recommended if a meningocele or meningomyelocele is present.
Risks: Risks for any anesthesia include the following: - Reactions to medications
- Problems breathing
Risks for any surgery include the following: Additional risks include the following:
Expectations after surgery: The long-term results depend on the initial condition of the spinal cord and nerves. Possible outcomes range from normal development to various types of paralysis (paraplegia), depending on the level of spinal cord involvement. With modern treatments, greater than 85% of infants survive, and about 50% will be able to walk. Hydrocephalus ("water on the brain") develops in about 70% of patients with myelomeningocele. It is already present in 5-10% of patients at birth. In patients with myelomeningocele and developing hydrocephalus, most surgeons will wait for a few days after repairing the myleomeningocele to treat the hydrocephalus with a shunt to relieve pressure. 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.
Convalescence: Patients usually spend about 2 weeks in the hospital after surgery. During this time the patient is kept flat without lying on the incision as it heals. Bladder catheterization is usually required.
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