Meningocele repair is an operation used to address a spinal birth

defect. If your newborns spine didnt develop correctly, an abnormal

opening may be present and this operation may be necessary. This
procedure may also be performed if a small, swollen sac or cyst
protrudes from the newborns spinal column.

The procedure usually takes place within 12 to 48 hours of a babys

birth. During the procedure, the surgeon will drain the excess spinal
fluid from the sac, close the opening, and repair the area of the defect.
This will allow the child to grow and develop normally.

PURPOSE

Who Needs A Meningocele Repair?

Newborns diagnosed with a birth defect called spina bifida may need
this operation. These babies experience a defect in the formation of the
spine. This typically happens during the first trimester. This defect
affects the spinal cord and the fluid-filled sac that surrounds the spinal
cord. Sometimes, this defect can affect the surrounding nerves.

Certain diagnostic tests performed during pregnancy can detect spina

bifida before the baby 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.

An amniocentesis test may also be performed. During this test, the

doctor will examine a small amount of amniotic fluid. This test can
most accurately diagnose the presence of a neural tube defect. The
neural tube is the precursor to the childs central nervous system.

Once the baby is born, a sac protruding from the spinal cord is usually
visible. This 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 babys spine. This can
ensure a correct diagnosis.

MENINGOCELE

What Is Meningocele?
Meningocele is a type of spina bifida. About 1,500 babies are born with
this condition each year. The defect can happen anywhere along the
spine where the neural tube doesnt close as it should. This leaves an
opening in the spine.

There are three main types of spina bifida.

Spina Bifida Occulta

This is considered to be a 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.

Meningocele

This is seen as mild to moderate 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. The sac contains little or no nerve tissue.

Myelomeningocele

This is a severe form of spina bifida. The spinal cord and nerves develop
outside the babys body. This results in weakness and loss of sensation
below the defect. It can interfere with bowel or bladder function or
cause fluid to build up in the brain.

A D V E RT IS E M E N T
THE SURGERY

How Is Meningocele Repair Performed?

Once the baby is diagnosed with meningocele, the doctor will most
likely schedule surgery as soon as possible. An early surgery may
prevent infection, swelling, and further damage to the spinal cord. Until
the surgery, the defect will be covered with a sterile dressing. Your
child may be transferred to a neonatal intensive care unit.
During the surgery, general anesthesia will be used to make sure the
baby is asleep and experiences no pain. The surgeon will make an
incision in the sac or cyst in order to drain some of the excess fluid. The
spinal cord is then covered with the membranes for protection. The
surgeon will then close the incision.

RECOVERY

What Is Recovery Like?

Your baby will usually require about two weeks of recovery time 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 fluid buildup (hydrocephalus) that may
develop after the defect is repaired. Nurses will position the baby so
that baby lies on the stomach in order to avoid putting pressure on the
wound.

Results will depend on the amount of damage done to the babys spinal
nerves. Since meningocele typically doesnt 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 a
meningocele.

RISKS

What Risks and Complications Are Associated with

Meningocele Repair?
As with any surgery that involves general anesthesia, this procedure
carries a small risk of allergic reactions to the anesthesia medication.
Although bleeding, infection, and fluid build up are rare, theyre
possible. Your doctor will advise you about how to care for your baby at
home. Your doctor will also tell you which symptoms to watch for in
order 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. Problems may indicate muscle weakness, speech problems,
or other potential issues related to the neural tube defect.

A D V E RT IS E M E N T
MENINGOCELE PREVENTION

Can I Prevent Meningocele?

There isnt any one cause of spina bifida. Your genetic makeup plays
the most significant role. 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
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. If possible, check with your doctor about your
prescriptions before becoming pregnant. Diabetes and obesity also
somewhat increase your risk of having a baby with meningocele.
Because of this, its important that you maintain a healthy weight and
control your blood sugar levels.

Article resources

Developing a sense of belonging, learning, and

contributing can help your child develop healthy
self-esteem. The following are ways you can help
promote this development in your child.
Belonging
Through contact with others, we know that we
are loved and respected and that we belong. Use
the following suggestions to help your child feel
he or she belongs within your family.
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Show your love. Let your child know you love him or
her for who he or she is, not for what he or she does.
Make it a habit to show your love for your child in at
least two ways each day.
Let your child know that he or she is special. List at
least three of your child's good qualities and post them on
your refrigerator. Add to these qualities from time to
time. Celebrate your child's good qualities often.
Praise your child. Make positive comments about your
child's behavior. Notice your child's strengths, even when
he or she is misbehaving. When you focus on what you
like, your child's behavior may improve.
 Listen to your child. When your child shares something
with you, give him or her your undivided attention and
listen carefully. Don't give advice unless asked for it or
you feel your child's safety is involved. Don't ridicule or
shame your child.
Have family times. Have regular times for the family to
have fun together, such as playing board or card games.
Try to have as many family meals together as possible.
Don't discuss problems or concerns you have with your
child during these times unless it is absolutely needed.
Encourage positive peer experiences. Look for
activities with peers where your child can feel success
and acceptance, such as participating in a sport or joining
a club.

Learning
Although learning really takes place all the time, plan to create
a learning opportunity for your child at least once a week.

Choose a learning activity. Choose an activity that is

appropriate for your child's age and that builds on his or
her strengths. Do not overstress the danger or difficulty
involved in a task or activity. You might invite your child
to help with one of your chores or hobbies. If you do, be
sure that you are not feeling rushed during the activity.
Let it be a fun time.
Let your child try. Even if your child has difficulty with
a new task or skill, don't quickly take over and show him
or her how to do it. Be patient and let your child try.
Break up a complex task. Simple steps help a child see
progress when learning a complex skill. Don't embarrass
your child by asking him or her to do difficult tasks in
front of other people.
Praise accomplishments. Even if the completed work
does not meet your standard, find at least one positive
thing to say.
 Encourage practice. When your child is learning a new
skill that takes practice, such as riding a bicycle, don't
expect perfection the first time. Help your child to not
give up on the first try. Encourage your child to practice
and talk about his or her improvement with each practice
time.

Contributing
Contributing enhances our feelings of belonging, providing the
basis for continued learning and strengthening of self-esteem.
Every day, use the following suggestions to help your child feel
that he or she is contributing.

Set family rules. Family rules help children know that

the family stands for something and gives them exposure
to order and ritual. Have as few family rules as possible
and enforce them consistently. Write down(What is
a PDFdocument?) your family's rules and the
consequences if those rules are broken.
Invite cooperation. Regular family meetings are a way
to help children learn to cooperate. Family meetings are a
place where family members discuss concerns and
problems.
Expect accountability. You can help your child learn to
be responsible by assigning him or her some household
chores. Make sure the chores are appropriate for your
child's age. As your child grows, hold your child
accountable for his or her choices and behavior and let
your child experience natural or logical consequences.
Express appreciation. Let your child know you
appreciate his or her help with tasks, even household
chores.

You may want to keep a journal when you are starting to use
this method. Each day for at least 3 weeks, write in your
journal specifically how you helped your child develop a sense
 of belonging, learning, and contributing. Keeping a journal for
an extended period of time will help encourage positive
behavior. After 3 weeks, review your notes to see your child's
progress and to identify new ways to help your child.

What is Meningocele?
A meningocele is a birth defect where there is a sac protruding from the spinal column.

The sac includes spinal fluid, but does not contain neural tissue. It may be covered with skin or with
meninges (the membranes that cover the central nervous system). The sac often is visible from the
outside of the back.

Meningoceles are considered to be neural tube defects and are a form of spina bifida. It is the least
common type of spina bifida. Spina bifida occurs in about 1 out of every 1,000 births.

To close meningoceles at the skull base or top of the spine, our surgeons may use the minimally
invasive Endoscopic Endonasal Approach (EEA). This innovative, minimally invasive technique
uses the nose and nasal cavities as natural corridors to access hard-to-reach or previously
inoperable tumors or lesions. Benefits of EEA include:

no incisions to heal
no disfigurement
faster recovery time

EEA has proven safe and effective in children. More than 100 children have been treated by UPMC
skull base surgeons using EEA more than at any other neurosurgery center in the world.

For closing meningoceles lower in the spine, our specialists use minimally invasive spine surgery
techniques.

Diagnosing Meningocele
Meningoceles are typically diagnosed before birth. A doctor may make the diagnosis through:

Ultrasound
Amniocentesis
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.

Meningocele Treatment

Surgery
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