Developmental disorders

II./4.6.: Therapy

If meningocele or myelomeningocele is open, and the cerebrospinal fluid leaks through the cleft region or damaged sacs, the danger of infection (meningitis) indicates urgent surgical treatment (photo 1-3)

Photo 1.

Photo 2.

Photo 3.

So far as the cele is intact and covered with skin and the risk of injury or rupture is low, the surgery can be performed after the perinatal period. Reconstructive surgery for myelomeingocele or menigocele requires detailed operative planning and analysis of the anatomical situation by MRI scans. While closing up the defect, surgeons have to pay great attention to avoid the damage of the existing neural functions (photo 4-5).

Photo 4-5.

Therefore, in case of myelomeningocele, a neurophysiological monitoring is necessary to make the separation of functioning and non-functioning tissue possible. During surgery, we try to reconstruct corresponding normal tissue layers such as spinal cord, dura, muscle, fascia, subcutis and skin. The prominently important part of surgery is to prevent leakage of cerebrospinal fluid through the layers. For larger sized defects plastic surgical flap rotating methods may be necessary.