Writing & Editing for MedicineNet.com Is Work!

I am proceeding through the alphabet, editing terms in the medical dictionary. Right now, I am immured in the M's -- buried in them, like up to my neck in the sand of terms starting with the letter M.

The first definition I see this morning is:

  • Meningomyelocele: Protrusion of the membranes that cover the spine and some of the spinal cord itself, due to spina bifida, a defect in the bony encasement of the vertebral column. See also spina bifida.

Well, that does not seem quite right, I think, but why? The membranes (also referred to as meninges) are not all that protrudes through the defect in the vertebral column. The spinal cord is also protruding. And that is why it is called a meningomyelocele (meningo- for the meningeal membranes and -myelo- for the spinal cord).

I try again.

  • Meningomyelocele: Protrusion of the spinal cord and the membranes covering it through a defect in the vertebral column. Sometimes called a myelomeningocele. See also spina bifida.

But that says nothing about the cause of the problem - or what it looks like - or how it might be detected before birth, so it's back to the grindstone to sharpen it up a bit more.

  • Meningomyelocele: Protrusion of the spinal cord and the membranes covering it through a defect in the vertebral column. This is due to failure of the neural tube to close during fetal development. The infant is born with a defect in the lumbar section of the spine through which bulges a skin-covered sac containing the meninges (the membranes) and part of the spinal cord. This neural tube defect can sometimes be suspected prenatally by elevation in the mother's blood level of AFP and confirmed by ultrasound. Sometimes called a myelomeningocele. See also AFP, meninges, neural tube defect, spina bifida.

That may be a little more informative. But what can be done to help the child? Let's try again. Here goes.

  • Meningomyelocele: Protrusion of the spinal cord and the membranes covering it through a defect in the vertebral column. The defect is due to failure of the neural tube to close during fetal development. The infant has a hole in the lumbar spine through which bulges a skin-covered sac containing the meninges (the membranes) and part of the spinal cord. Meningomyelocele may be suspected prenatally by elevation in the mother's serum AFP and confirmed by ultrasound. Delivery should ideally be done by C-section to protect the skin covering the sac and prevent infection of the spinal cord within it and the child should then have surgery to repair the defect. Sometimes called a myelomeningocele. See also AFP, meninges, neural tube defect, spina bifida.

That is most of what needs to be said, I think, in a miniature encyclopedic entry. The dictionary is not exclusively a dictionary with one-line definitions. We do have some entries of that sort, but we have many entries that are of the-situation-in-a-nutshell type. This one is evolving into a nutshell entry.

The current entry to meningomyelocele still leaves some key questions to be addressed in brief, including the outcome for the baby, prominent complications, and prevention of the problem in the first place. So I try again.

  • Meningomyelocele: Protrusion of the spinal cord and the membranes covering it through a defect in the vertebral column. The defect is due to failure of the neural tube to close during fetal development. The infant has a hole in the lumbar spine through which bulges a skin-covered sac containing the meninges (the membranes) and part of the spinal cord. Meningomyelocele (MM) may be suspected prenatally by elevation of the mother's serum AFP and confirmed by ultrasound. Delivery should ideally be done by C-section to protect the skin covering the sac and prevent infection of the spinal cord. Surgery is then done to repair the defect and, if need be, a shunt is inserted to treat hydrocephalus which commonly accompanies MM. The baby may still be left with neurological deficits involving loss of nerve control over the bowel, bladder, and legs. The risk of MM is raised for future children in an MM family. Folic acid intake during the childbearing years lowers the risk of MM. Sometimes called a myelomeningocele. See also AFP, meninges, neural tube defect, spina bifida.

Next I check the cross-references. There is already one for MM but there is none for myelomeningocele, so I insert one:

Myelomeningocele: See meningomyelocele.

That's it. My initial part of the process is done.

After I have finished with the M's (and hopefully emerged from the "M" tomb), all of the M's including meningomyelocele will be sent to my fellow medical editor for his review. He may wield his scalpel and excise some verbiage, correct a fact, and do whatever he deems necessary (just as I do with his entries) to revise it.

Finally, meningomyelocele and the host of other M's will go to the publisher for our publisher's approval, or for changes by their editorial team. All of this labor-intensive process may not ensure a perfect product, but I hope it makes for a more reliable and informative entry in our medical dictionary.

Now onto the next entry. It is to Menkes syndrome. Since the prior edition of the dictionary, the gene responsible for Menkes syndrome has been discovered. Better add that and then...off I go!

Medical Author: Frederick Hecht, MD, FAAP, FACMG
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR


Last Editorial Review: 8/27/2002




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