SPINA BIFIDA

MYELOMENINGOCELE

Neural Tube Defects

Neural Tube
Development
Normal embryological
development
Neural plate
development -18th day
Cranial closure 24th
day (upper spine)
Caudal closure 26th
day (lower spine)

What is Spina Bifida?

A midline defect of the
bone,
skin,
spinal column, &/or
spinal cord.

Preventive Care
The United States Public Health Service recommends
that: "All women of childbearing age in the United
States who are capable of becoming pregnant
should consume 0.4 mg of folic acid per day for the
purpose of reducing their risk of having a pregnancy
affected with spina bifida or other neural tube
defects." Folic acid is a "B" vitamin that can be found
in such foods as: cereals, broccoli, spinach, corn and
others, and also as a vitamin supplement.

Types of Myelodysplasia*
Spina bifida occulta
Spina bifida aperta (cystica)
Lipomeningocele
Meningocele
Myelomeningocele

SPINA BIFIDA OCCULTA

Spina bifida occulta
(occulta = closed)
A condition involving nonfusion
of the halves of the
vertebral arches without
disturbance of the
underlying neural tissue

SPINA BIFIDA APERTA

MYELOMENINGOCELE
Incidence
1-2/1000
Risk increase with previous birth with MM
Also increase in families where close relatives
(siblings) have given birth to MM children

LATEX ALLERGY IN MYELOMENINGOCELE

Up to 73% MM pts are allergic to protein
presence in latex
This may arise due to early and frequent
exposure to latex products

Diagnosis and Detection

Amniocentesis
AFP - indication of abnormal leakage

Blood test
Maternal blood samples of AFP
Ultrasonography
For locating back lesion vs. cranial signs

MANAGEMENT

TIMING OF CLOSURE
RUPTURED: EMERGENCY CLOSURE
UNRUPTURED:
URGENT CLOSURE VS RULE OF 10

MM DEFECT CLOSURE AND VP SHUNT

ONE STEP
MM DEFECT CLOSURE ONLY AND OBSERVE IF
SIGN OF HYDROCEPHALUS DEVELOP
VP SHUNT

NEUROLOGICAL ASSESMENT AND

MANAGEMENT
MOTORIC
SPONTANEOUS MOVEMENT
MOTOR POWER
JOINT AND EXTREMITIES DEFORMITIES
CLUB FOOT
CTEV

SENSORIC
AUTONOM
BLADDER EMPTYING
MORNING GLORY

Prognosis
Spina bifida is a:
static
non-progressive defect
with worsening from secondary problems.
The prognosis for a normal life span is generally
good for a child with good health habits and a
supportive family/caregiver.

Arnold Chiari Malformation

Arnold Chiari type II
Malformation:
cerebellar hypoplasia
(hypoplasia = reduced
growth)
with caudal displacement
of the hindbrain through
the foramen magnum
usually associated with
hydrocephalus

SYRINGOMYELIA