Prenatal Detection

The overall incidence of meningomyelocele appears to have decreased in recent years, at least in part, because of prenatal testing. Serum alpha-fetoprotein examination (a blood test given to the mother during pregnancy) and ultrasonography can identify a large number of these afflicted fetuses between 16 and 20 weeks. Many parents have then made the decision to interrupt the pregnancy, which is probably why there has been a significant decrease in the number of those born with this anomaly.

One of the serious questions faced by pediatric neurologists, pediatric neurosurgeons, and obstetricians is how to advise parents of such afflicted babies who seek advice. There is no easy recommendation, it is necessary to weigh a number of issues in an overall assessment of the problem. This is an awesome responsibility for any physician, and there are really no guidelines. If a child has a large lesion, advanced hydrocephalus, and little mobility of the lower extremities, it is easy to predict that neurological function will be severely limited. However, smaller lesions without significant hydrocephalus are a much more difficult problem, even after lengthy discussion, there is often no obvious right or wrong decision. It is a very personal one, and must be made by parents after all the appropriate information is made available to them.

Peter Semczuk,