Supervisor: dr.

Nick, SpBS

Keyne Christa Monintja (2013-061-111) | Angelina Tjokro (2013-

 The neural structures develop from the ectoderm.

The neural tube forms from the neural placode at
approximately 21 days of gestation.
Failure to form neural tube defects (spinal dysraphism)
.
The neural tube defects have already formed by the time
pregnancy is diagnosed prevention : folic acid prior to
21days of gestation.

Normal embryological
development
Neural plate
development -18th day
Cranial closure 24th
day (upper spine)
Caudal closure 26th
day (lower spine)

 Unknown
Multifactorial
Genetic = single gene mutation (eg. Meckels
syndrome) & chromosomal abnormalities (trisomy 13,
trisomy 18)
Nutrition
Intake zinc, folic acid reduce spina bifida incidence
Environmental factor = lower socioeconomic status
Racial
Alcohol consumption
Maternal problems
Use of anti epileptic drugs, maternal diabetes,
hyperthermia, obesity

SPINAL DYSRAPHYSM
Spina Bifida APERTA

Spina Bifida OCCULTA

Meningocele

Simple Spina Bifida

Occulta

Myelomeningocele

Spinal Dermal Sinus

Lipomyelomeningocele

Diastematomelia
Tethered Spinal Cord

 Protrusion of dura and arachnoid outside the confines of

the spinal canal, with neural tissue remaining within the
spinal canal confines.
No neural elements present no associated neural
deficits repair is simpler.
Can be at any location in the spine, most common in the
lumbar region.

 Surgical treatment 12 to 24 hours after birth prevent

infection, swelling, and further damage.
1. Using general anesthesia
2. An incision is made in the sac and some of the excess
fluid is drained off
3. The spinal cord is covered with the membranes
(meninges)
4. The skin is closed over the protruding meninges, spinal
cord, and nerves.

A midline defect of the

bone,
skin,
spinal column, &/or
spinal cord.

 Spina bifida is a congenital abnormality, a defect in the

posterior arch of the spine as a result of the failure of
neural tube closure in the early embryo

 The most mild, sometimes called hidden spina bifida

Neural defect covered by skin. There is a small gap in the
spine, but no opening or sac on the back. The spinal cord
and the nerves usually are normal.
Processus spinous always lost, the laminae may be lost
Occur in the lumbosacral region (L4-S1)

 The most often, the most serious type

With this condition, a sac of fluid comes through an
opening in the babys back. Part of the spinal cord and
nerves are in this sac and are damaged.
Causes moderate to severe disabilities

 Leg weakness and paralysis

Orthopedic abnormalities (i.e., club foot, hip
dislocation, scoliosis)
Bladder and bowel control problems, including
incontinence, urinary tract infections, and poor renal
function
Pressure sores and skin irritations
Abnormal eye movement
Hydrocphalus

 A sac sticking out of the mid to lower back, dimpling of

the sacral area.
Motor, sensory and autonomic deficit related to the level
of the defect.
Symptoms include : loss of bowel and bladder control,
paralysis or weakness of the legs, loss of sensation.

Amniocentesis
AFP - indication of abnormal leakage

Blood test
Maternal blood samples of AFP
Ultrasonography
For locating back lesion vs. cranial signs

 Surgical closure of the myelomeningocele is undertaken

within 24 to 48 hours of birth to avoid CNS infection.
The defect covered by moist sterile dressings,and given
prophylactic antibiotics
Skin grafts often are required for large defects.
Ventricular shunts, if indicated, are placed concurrently
with myelomeningocele closure or at a later

 children with myelomeningocele, 60% to 70% will

ultimately require a shunt insertion, whereas only 15% to
30%
(24% over a 25-year period), cognitive development
(75% have an IQ higher than 80 if adequately treated for
hydrocephalus),