Treatment Options

It is very complicated and difficult to explain all the potential problems associated with meningomyelocele in a single session with a parent. The first question always asked is whether there is permanent brain damage, and if the child will have useful lower limb function. Unfortunately, the neurologist or neurosurgeon can always predict the minimal expected deficits, but not the maximal ones. If a child is paraplegic, one may say with certainty that this patient will always remain in a wheelchair. On the other hand, if the child is born with a L3 or L4 level, the chances are good for walking with some sort of brace support. When there are no anomalies of the brain (maldevelopment), it is always possible that intelligence will be normal or above, even if there is advanced hydrocephalus at birth. Thus it is possible to predict for a family how well the child will do, but not how poorly.

The basic treatment for meningomyelocele has been well established for many years. The surgeon must replace the neural tissues within the spinal canal and then close the muscle and the skin. A plastic surgeon is occasionally needed if there is a large area that may be difficult to close. If there is also significant hydrocephalus, most pediatric neurosurgeons now place a ventriculo-peritoneal shunt (see Hydrocephalus and its Treatment (Shunts)) at that same procedure. This does not appear to increase the hazard of infection, and decreases the chance of wound disruption in the lumbosacral region as a result of transmitted spinal fluid pressure. Meningomyelocele used to be considered an emergency, and surgery was carried out within a few hours of birth. Nowadays the situation is viewed as urgent but not emergent, in most centers it is considered entirely sufficient to close the back within 2 days of birth. Until then, the tissues are simply kept moist with a saline dressing.

Mary Anne Gallagher, RN, C MA