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2023 Author: Benjamin Dyson | [email protected]. Last modified: 2023-05-21 01:37
Myelomeningocele is the most serious type of spina bifida, in which the baby's spinal bones do not develop properly during pregnancy, causing a pouch in the back that contains the spinal cord, nerves and cerebrospinal fluid to appear..
Usually, the appearance of the myelomeningocele pocket is more frequent in the lower back, but it can appear anywhere on the spine, causing the child to lose the sensitivity and function of the limbs below the site of the alteration.
Myelomeningocele has no cure because, although it is possible to reduce the pouch with surgery, the lesions caused by the problem cannot be completely reversed.
The main symptom of myelomeningocele is the appearance of a back pouch in the baby, however, other signs include:
- Difficulty or lack of movement in the legs;
- Muscle weakness;
- Loss of sensitivity to heat or cold;
- Urinary and fecal incontinence;
- Malformations in the legs or feet.
Typically, the diagnosis of myelomeningocele is made at birth by observing the pouch on the baby's back. In addition, the doctor usually requests neurological examinations to check for any nerve involvement.
What causes myelomeningocele
The cause of myelomeningocele is still not well established, however it is believed to be the result of genetic and environmental factors, and is usually related to a family history of spinal malformations or folic acid deficiency.
In addition, women who used certain anticonvulsant medications during pregnancy, or who have diabetes, for example, are more likely to have myelomeningocele.
To prevent myelomeningocele, it is important that pregnant women supplementation with folic acid before and during pregnancy, because in addition to preventing myelomeningocele, it prevents premature birth and preeclampsia, for example. See how folic acid supplementation should be done during pregnancy.
How the treatment is done
Treatment of myelomeningocele is usually started within the first 48 hours after birth with surgery to correct the change in the spine and prevent the emergence of infections or new spinal cord injuries, limiting the type of sequelae.
Although the treatment for myelomeningocele with surgery is effective in curing the injury in the baby's spine, it is not able to treat the sequelae that the baby has since birth. That is, if the baby was born with paralysis or incontinence, for example, it will not be cured, but will prevent the emergence of new sequelae that could arise from spinal cord exposure.
How the surgery is performed
Surgery to treat myelomeningocele is usually done in the hospital under general anesthesia and should ideally be performed by a team that includes a neurosurgeon and a plastic surgeon. That's because it usually follows the following step-by-step:
- The spinal cord is closed by the neurosurgeon;
- The back muscles are closed by a plastic surgeon and neurosurgeon;
- The skin is closed by the plastic surgeon.
Often, as there is little skin available at the site of the myelomeningocele, the surgeon needs to remove a piece of skin from another part of the baby's back or bottom, in order to extract and close the opening in the back.
Additionally, most babies with myelomeningocele can also develop hydrocephalus, which is a condition that causes excessive accumulation of fluid within the skull and, as a result, may require further surgery after the first year of life. to put in a system that helps to drain fluids to other places in the body. Learn more about how hydrocephalus is treated.
Is it possible to have surgery on the uterus?
Although it is less frequent, in some hospitals, there is also the option of having surgery to close the myelomeningocele before the end of pregnancy, while still inside the pregnant woman's uterus.
This surgery can be done around 24 weeks, but it is a very delicate procedure that should only be done by a well-trained surgeon, which ends up making the surgery more expensive. However, the results of surgery in utero appear to be better, as there is less possibility of further spinal cord injury during pregnancy.
Physiotherapy for myelomeningocele
Physiotherapy for myelomeningocele should be performed during the baby's growth and development process to maintain joint range and prevent muscle atrophy.
In addition, physiotherapy is also a great way to encourage children to deal with their limitations, such as in the case of paralysis, allowing them to have an independent life, through the use of crutches or a wheelchair, for example.
When you return to the doctor
After the baby is discharged from the hospital, it is important to go to the doctor when symptoms such as:
- Fever above 38ºC;
- Unwillingness to play and apathy;
- Redness at the surgical site;
- Decreased strength in unaffected limbs;
- Frequent vomiting;
- Dilated moleira.
These symptoms can indicate serious complications, such as infection or hydrocephalus, so it's important to get to the emergency room as soon as possible.