Meningocele repair is an operation to address a type of birth defect in which the spine does not develop properly and a small, swollen sac or cyst protrudes from a newborn’s spinal column. The procedure usually takes place within 12 to 48 hours of a baby’s birth.
During the procedure, the surgeon drains the excess spinal fluid from the sac, closes the opening, and repairs the area of the defect, which allows the child to grow and develop normally.
Who Needs a Meningocele Repair?
Newborns diagnosed with a birth defect called “spina bifida” may need meningocele repair.
These children experience a developmental defect, typically during the first trimester, which affects the spinal cord, the fluid-filled sac that surrounds the spinal cord, and sometimes the surrounding nerves.
These defects are called “open neural tube” defects.
Certain diagnostic tests performed during pregnancy can detect spina bifida before the child is born. Blood tests performed between 15 and 20 weeks can reveal if the fetus is at risk of a neural tube defect.
A prenatal ultrasound that takes images of the fetus’ tissues and organs may also lend some insight.
Amniocentesis, in which a small amount of amniotic fluid is withdrawn for examination, can most accurately diagnose the presence of a neural tube defect.
Once the baby is born, a sac protruding from the spinal cord is usually visible, which can confirm an earlier diagnosis of spina bifida.
The doctor may use X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) to further examine the baby’s spine and ensure a correct diagnosis.
What is Meningocele?
Meningocele is a type of spina bifida. According to the Centers for Disease Control and Prevention (CDC), each year about 1,500 babies are born with spina bifida.
(CDC) The defect can happen anywhere along the spine where the neural tube—the precursor to the child’s central nervous system—does not close as it should, leaving an opening in the spine.
There are three main types of spina bifida.
Spina bifida occulta
In this mild form of the defect, the spinal cord and surrounding structures are still inside the baby, but the bones of the lower back fail to form normally. This leaves a hairy patch or dimple over the affected area of the spine.
This is considered a mild to moderate form of spina bifida and is the least common. A small, moist sac or cyst protrudes through the gap in the spine.
This sac contains a portion of the spinal cord membrane (meninges), and some spinal fluid. The sac may be covered with skin or part of the spinal cord membrane, but contains little or no nerve tissue.
This is a severe form of spina bifida in which the spinal cord and nerves develop outside the baby’s body, resulting in weakness and loss of sensation below the defect.
How is Meningocele Repair Performed?
Once the baby is diagnosed with meningocele, the doctor will most likely schedule surgery as soon as possible to prevent infection, swelling, and further damage to the spinal chord.
Meanwhile, healthcare professionals will cover the defect with a sterile dressing, and your child may be transferred to a neonatal intensive care unit.
Using general anesthesia, surgeons make sure the baby is asleep and experiences no pain. They make an incision in the sac or cyst and drain some of the excess fluid.
The spinal cord is then covered with the membranes (meninges) for protection and the surgeons close the incision.
Meningoceles are typically diagnosed before birth. A doctor may make the diagnosis through:
- Alpha-fetoprotein (AFP) screenings in the second trimester
- Multiple-marking screening tests
The blood screening tests and amniocentesis can indicate a neural tube defect. The meningocele may be visible with an ultrasound.
What is Recovery Like?
Your baby will usually require about two weeks of recovery in the hospital after surgery. Doctors will administer antibiotics to prevent infection.
Additional tests, such as MRIs or ultrasounds, may be performed to ensure that the surgery site is healing normally.
These tests can detect any swelling or hydrocephalus (fluid buildup) that may develop once the defect is repaired. Nurses will position the baby so that she lies on her stomach to avoid putting pressure on the wound.
Results will depend on the amount of damage done to the baby’s spinal nerves by the defect. Since meningocele typically does not damage any of the neural tissues, surgery usually has excellent results.
Babies rarely have any lasting disabilities or brain, nerve, or muscle problems caused by their defect.
What Risks and Complications Are Associated with Meningocele Repair?
As with any surgery that involves general anesthesia, meningocele repair carries a small risk of allergic reactions to the anesthesia medication.
Bleeding, infection, and fluid build up, though rare, are also possible. Healthcare professionals will advise you about how to care for your baby at home and what symptoms to watch for to determine if there are any complications.
You may also be referred to a team of medical experts in spina bifida, who will follow-up with you and your baby after you leave the hospital.
These professionals will work with you to help detect any additional problems that may indicate muscle weakness, speech problems, or other potential issues related to the neural tube defect.
Treating the meningocele involves closing the overlying meninges and the skin. Surgery is performed within a day or two of birth, and is necessary to prevent infection and to protect the exposed area of the spine.
Endoscopic Endonasal Approach (EEA)
Meningoceles at the skull base and top of the spine can be approached directly by using the Endoscopic Endonasal Approach (EEA).
This state-of-the-art, minimally invasive approach allows surgeons to access the affected area through the natural corridor of the nose, without making an open incision. Surgeons then remove the meningoceles through the nose and nasal cavities.
EEA offers the benefits of no incisions to heal, no disfigurement, and a faster recovery time.
UPMC’s neurosurgical team may recommend a combination of surgical and non-surgical approaches to treat the meningocele.
For meningoceles in the lower spine, UPMC spine specialists use minimally invasive spine surgery techniques to close the sac.
Can I Prevent Meningocele?
There is no single cause of spina bifida, and your genetic makeup plays the most significant role. However, getting enough folic acid during pregnancy has been shown to help prevent the condition.
Sources of folic acid include whole grains, fortified breakfast cereals, dried beans, green leafy vegetables, egg yolks, citrus fruits, and fruit juices. During pregnancy, talk to your doctor about taking folic acid supplements.
Some medications may put you at additional risk for giving birth to a child with spina bifida, so check with your doctor about your prescriptions prior to pregnancy.
Diabetes and obesity also somewhat increase your risk of having a baby with meningocele, so try to maintain a healthy weight and control your blood sugar levels.