Introduction:
Most babies are born perfect as new human beings after staying in their mother's womb for almost nine to ten months. However, in rare cases, some babies undergo defects in their growth while still in the womb. Such babies are known to be born with congenital defects. Meningocele is one of those common congenital defects where a baby undergoes abnormal formation of the spinal cord. This results in an abnormal dilation or enlargement of the meninges, which are filled with cerebrospinal fluid (CSF). There are no nerves in the meningocele. This abnormal enlargement communicates with the subcutaneous tissue because there is a defect in the bones, which normally cover the spinal cord and meninges. A thin layer of skin covers this sac.
What Is a Meningocele?
Meningocele is a common congenital defect seen in the baby’s back or neck. It is a type of spina bifida. Here, in this condition, the baby has an abnormally formed spine with a gap in between the vertebral bones. This results in developing a sac of cerebrospinal fluid (spinal fluid) covered by a thin layer of skin that may or may not be seen outside the body. This sac of cerebrospinal fluid called a meningocele, is seen in the lower back or neck.
Meningomyelocele is an open spina bifida, which is a devastating congenital malformation of the CNS (central nervous system). This condition is associated with severe morbidity and mortality.
What Is the Life Expectancy of Spina Bifida?
Most of the children who are born with this condition will survive their three decades of life.
What Is the Difference Between Meningocele vs Myelomeningocele?
Meningocele: This condition is a defect in the posterior region of the spine along with extrusion of CNS (cerebrospinal fluid) and meninges. The neural element does not get involved.
Myelomeningocele: In this condition, there will be an extrusion of CNS, meninges, as well as neural elements.
What Causes Meningocele?
The accurate cause of meningocele is yet to be known. Some baby-bearing mothers are at a higher risk of giving birth to a baby with spina bifida. Some of the common risk factors are If a mother lacks folic acid during pregnancy. Past history of having a baby with meningocele. Antiepileptic drugs like Phenytoin or Valproate intake during pregnancy. Meningocele is known to occur during the first trimester of pregnancy. At first, the fetus’s spinal cord is flat, which later forms into a tube, a neural tube. When this tube does not fuse properly, then the baby is known to be born with meningocele.
What Are the Common Signs and Symptoms Associated With Meningocele?
Usually, meningocele is not visible over the skin, but there could be some tell-tale signs like abnormal hair patches at the back or soft tissue swelling of fat, known as lipoma. Most babies born with meningocele might not experience any symptoms. However, in some babies, when meningocele causes damage to the surrounding nerve tissues, specific issues related to the nerves can develop.
Some of them are as follows:
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Some issues with movements.
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The baby might find it difficult to control their pee and poop.
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Aesthetic issues with a protruding sac of spinal fluid outside the body.
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Gastrointestinal problems, bowel obstruction, leaking stools, and constipation are common.
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Neurological issues like paralysis of the lower body or physical deformity can occur.
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Overactive muscle reflexes.
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Muscle stiffness.
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Muscle weakness.
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Recurrent urinary tract infections.
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Inability to control urine and bedwetting.
What Are the Complications Associated With Meningocele?
Meningoceles do not usually cause any life-threatening complications and are known to have an excellent prognosis if detected early and followed properly. However, in some cases with untreated meningoceles, the infants may develop some of the following complications:
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Meningoceles can increase intracranial pressure.
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The cerebrospinal fluid leak can occur due to the erosion of the base of the skull.
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Hydrocephalus is often seen as associated with myelomeningocele.
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Tethered cord syndrome (a condition characterized by symptoms related to increased tension in the spinal cord).
Are There More Types of Spina Bifida?
Spina bifida can be classified into the following types namely:
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Myelomeningocele: This condition is characterized by a protruding sac that pushes through the gap in the spine. The sac contains spinal fluid and meninges and is seen outside the body of the infant, usually in the lower back.
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Spina Bifida Occulta: In this case, there is a gap between the spinal bones, but a sac of spinal fluid does not usually push out of the baby’s body.
How to Diagnose Meningoceles?
Meningocele can be diagnosed before the birth of a child by the following diagnostic methods:
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Regular monthly ultrasound scans.
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Amniocentesis (a procedure where the amniotic fluid that surrounds and protects a baby inside the womb is tested).
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Alpha-fetoprotein (AFP) can be tested during the second trimester.
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Multiple marking screening tests can be done.
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The meningocele can be visible in ultrasound, while amniocentesis can denote a neural tube defect.
What Are the Treatment Measures for Meningocele?
Meningocele shows an amazing prognosis after treatment. Appropriate treatments can avoid complications, and the babies are known to live a normal and healthy life thereafter. Mostly, surgery is performed within a few days after birth, where the spinal contents are put back into the spinal cord, and the opening is closed surgically to avoid infections.
Endoscopic Endonasal Approach (EEA): This surgery method is a minimally invasive surgical approach where a surgeon approaches the meningoceles present in the upper back or at the base of the skull via a nasal corridor. This prevents making an evident incision, which in turn prevents scarring. Then, the doctor removes the meningocele without causing any damage to the surrounding vital structures. EEA provides fast recovery and has very few complications.
How Can Parents Help During Meningocele?
Most affected babies do well, and they require regular check-ups with doctors to ensure that they are developing normally.
Conclusion:
Recent advances in medicine have developed several advanced methods to treat spina bifida, enhancing the quality of life of infants born with this congenital defect. A regular monthly ultrasound checkup during pregnancy can help the doctor plan appropriate treatments before birth. Also, after the surgical treatment, the parents are asked to bring the baby in regular intervals for a follow-up to assess and prevent further complications associated with meningocele.
