Overview of the management of myelomeningocele (spina bifida)
- David G McLone, MD, PhD
David G McLone, MD, PhD
- Professor of Pediatric Neurosurgery
- Northwestern University's Feinberg School of Medicine
- Ann and Robert Lurie Children's Hospital of Chicago
- Robin M Bowman, MD
Robin M Bowman, MD
- Associate Professor of Neurological Surgery
- Northwestern University's Feinberg School of Medicine
- Ann and Robert H Lurie Children's Hospital of Chicago
- Section Editors
- Marc C Patterson, MD, FRACP
Marc C Patterson, MD, FRACP
- Section Editor — Pediatric Neurology
- Professor of Neurology, Pediatrics, and Medical Genetics
- Chair, Division of Child and Adolescent Neurology
- Mayo Clinic College of Medicine
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
- Teresa K Duryea, MD
Teresa K Duryea, MD
- Section Editor — General Pediatrics
- Associate Professor of Pediatrics
- Baylor College of Medicine
Neural tube defects (NTDs), are the most common congenital central nervous system anomaly, and are the cause of chronic disability of between 70,000 and 100,000 individuals in the United States. Myelomeningocele (spina bifida) is the most common NTD. It is characterized by a cleft in the vertebral column, with a corresponding defect in the skin so that the meninges and spinal cord are exposed. Patients with myelomeningocele may have weakness and absence of sensation affecting the lower extremities and bowel/bladder dysfunction, depending upon the level of the spinal lesion.
An overview of the management of myelomeningocele and its complications will be presented here. Occult spinal dysraphism is discussed separately. The pathophysiology, clinical manifestations, prenatal diagnosis, orthopedic management, and urologic management of myelomeningocele are also discussed separately:
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- PRENATAL COUNSELING AND CHOICE OF MANAGEMENT
- FETAL SURGERY
- LABOR AND DELIVERY
- MANAGEMENT OF THE NEONATE
- Surgical closure
- SUBSEQUENT MANAGEMENT
- Neurologic complications
- - Routine surveillance
- - Shunt malfunction
- - Tethered cord
- - Chiari II
- - Hydromyelia
- - Seizures
- - Cognitive development
- Urinary tract complications
- Bowel management
- Pressure ulcers
- Orthopedic problems
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS