MoonDragon's Women's Health Pregnancy Information
(Neural Tube Defects)
SPINA BIFIDA DESCRIPTION
Spina Bifida is one of the anomalies of the nervous system. It is potentially serious because there is a danger that the child will be left with enough neurologic disorders to affect total functioning.
Although the term spina bifida (Latin for "divided spine") is most often used as a collective term for spinal cord involvement, there are well defined degrees of spina bifida involvement. All of these disorders occur because of lack of fusion of the posterior surface of the embryo in early intrauterine life.
FOLIC ACID DEFICIENCIES
Studies have shown that insufficient levels of Folic Acid at the time of conception and during the embryonic stage of development may be a major contributor to neural tube disorders. Folic acid helps to regulate embryonic and fetal nerve cell formation, which is vital for the normal development. Women, before and during pregnancy, need to have a minimum daily intake of 400 micrograms to prevent the vast majority of neural tube defects such as spina bifida and anencephaly. To be effective, this regiment must be started before and continue for at least the first 3 months of pregnancy. If a woman waits until she is pregnant, it may be too late, because the critical events in fetal development occur during the first six weeks of pregnancy - before most women know they are even pregnant.
The incidence is 1 to 3 per 1000 live births. They may occur as a polygenic inheritance pattern. Women who have had one child born with such a defect have an increased chance of having a second child born with such a defect (as great as 1 in 20). For this reason, women who have had one child born with a spinal cord are advised to have a maternal serum assay or an amniocentesis done to determine if such a defect exists in a second pregnancy. This is revealed by the presence of alpha-fetoprotein (AFP) in the serum or amniotic fluid escaping from an open cord lesion. These assessments are done at the fifteenth week of pregnancy, when AFP reaches its peak concentration.
Alpha-fetoprotein screening detects neural tube defects such as anencephaly, microcephaly, hydrocephaly and spina bifida. Unfortunately the test has a 20 percent false positive rate, so that ultrasound may be necessary for final diagnosis. Numerous states require informing parents of the benefits and risks of alpha-fetoprotein screening.
A. & B. Spina bifida, small defect A. & B. Spina bifida, banana sign, in which the outline of the cerebellum looks like a banana, probably because of the herniation at the spinal defect - the outline of the skull resembles a lemon (lemon sign).
C. & D. Portrays the outline of a normal skull and normal cerebellum.
TYPES OF SPINA BIFIDA
A. Normal spinal column
B. Spina bifida occulta
A. Spina Bifida Occulta. Spina bifida occulta is a developmental anomaly in which posterior spinal vertebrae fail to close. This anomaly usually involves one or two vertebrae at the sacral or lumbar area, although it may occur at any place along the spinal column. The spot is evident as a depression in the skin. Often there is a tuft of hair growing at the place of the depression.
B. Meningocele. A meningocele is a pouching of the meninges and cerebrospinal fluid through a defect in the posterior surface of the spinal vertebrae. The meningocele may be covered by a layer of skin, or it may be denuded, with just the fibrous dura matter exposed.
C. Myelomeningocele. A myelomeningocele is a pouching of the spinal cord, the meninges and cerebrospinal fluid through a defect in the posterior spinal vertebrae. Often the spinal cord ends at the level of the myelomeningocele, and so there will be no motor or sensory function below this point. As this is lower motor neuron damage, the child will have flaccidity of the lower extremities and loss of bowel and bladder control. The infant's legs are lax; the baby does not move them, and urine and stools continually dribble because of lack of sphincter control. It is generally difficult to tell from the gross appearance of the myelomeningocele whether or not it is the simpler meningocele.
A myelomeningocele protrudes as an obvious deformity of the spine and cord. Note how the area is covered only by a thin membrane, making it prone to trauma and infection.
D. Encephalocele. An encephalocele is a myelomeningocele occurring at the back of the neck or head. The sac contains brain tissue, as well as spinal cord, meninges, and fluid.
SPINA BIFIDA FETAL SURGERY
Spina bifida is a birth defect in which membranes and fluids of the spinal cord bulge through a gap into a large skin covered sac. In this sac, nerves are exposed, invariably leading to some degree of paralysis and often mental retardation.
The surgery treatment for spina bifida is done early in pregnancy on fetuses at gestational ages of 18 to 22 weeks.
1. Incision is made into the mother's abdominal cavity.
2. Incision is made into the mother's uterine muscles.
3. Incision is made into the skin-covered sac on the spinal area of the fetus to separate neural tissues from the surroundin skin and tissue.
4. Fetus's neural tissue is dropped into the central chamber of the spinal canal.
5. A protective tube is reconstructed for the fetus's spinal canal. Then the fetus and mother are stitched up.
Normal fetal spinal-brain anatomy & development while in the uterus.
Hydrocephalus: Build up of CSF compresses brain.
Chiari II Malformation: Back of brain is pulled down out of the skull into the top of the spinal canal.
Myelomeningocele: Protruding meninges and spinal cord.
Hydrocephalus: Decreased need for shunt.
Improved Chiari Malformation: Brain moves back into more normal position.
Protected Myelomeningocele: Spinal Cord Protected.
SPINA BIFIDA RESOURCE LINKS
SpinaBifida Association of New Orleans Spinabifida Association of America March of Dimes Lumps, Bumps & Holes Washington State Genetics Documents
Some photos from Diagnosis in color Obstetrics and Gynecology by Symonds and Macpherson.
PREGNANCY RELATED LINKS
MoonDragon's Womens Health Procedures: Amniocentesis
MoonDragon's Pregnancy Information: Pregnancy Information & Survival Tips
MoonDragon's Pregnancy Information Index
MoonDragon's Womens Health Pregnancy Information Index
MoonDragon's Pediatric Information Index
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