Spina Bifida and Anencephaly (cont.)
How is spina bifida treated?
There is no cure for spina bifida. The nerve tissue that
is damaged or lost cannot be repaired or replaced, nor can function be restored
to the damaged nerves. Treatment depends on the type and severity of the
disorder. Generally, children with the mild form need no treatment, although
some may require surgery as they grow.
The key priorities for treating myelomeningocele are to prevent infection
from developing through the exposed nerves and tissue of the defect on the
spine, and to protect the exposed nerves and structures from additional trauma.
Typically, a child born with spina bifida will have surgery to close the defect
and prevent infection or further trauma within the first few days of life.
Doctors have recently begun performing fetal surgery for treatment of
myelomeningocele. Fetal surgery—which is performed in utero (within the
uterus)—involves opening the mother's abdomen and uterus and sewing shut the
opening over the developing baby's spinal cord. Some doctors believe the earlier
the defect is corrected, the better the outcome is for the baby. Although the
procedure cannot restore lost neurological function, it may prevent additional
loss from occurring. However, the surgery is considered experimental and there
are risks to the fetus as well as to the mother.
The major risks to the fetus are those that might occur if the surgery
stimulates premature delivery such as organ immaturity, brain hemorrhage, and
death. Risks to the mother include infection, blood loss leading to the need for
transfusion,
gestational diabetes, and weight gain due to bed rest.
Still, the benefits of fetal surgery are promising, and include less exposure
of the vulnerable spinal nerve tissue and bones to the intrauterine environment,
in particular the amniotic fluid, which
is considered toxic. As an added benefit, doctors have discovered that the
procedure affects the way the brain develops in the uterus, allowing certain
complications—such as Chiari II with associated hydrocephalus—to correct
themselves, thus, reducing or, in some cases, eliminating the need for surgery
to implant a shunt.
Many children with myelomeningocele develop a condition
called progressive tethering, or tethered cord syndrome, in which their spinal
cords become fastened to an immovable structure—such as overlying membranes and
vertebrae—causing the spinal cord to become abnormally stretched and the
vertebrae elongated with growth and movement. This condition can cause loss of
muscle function to the legs, bowel, and bladder. Early surgery on the spinal
cord may allow the child to regain a normal level of functioning and prevent
further neurological deterioration.
Some children will need subsequent surgeries to manage problems with the
feet, hips, or spine. Individuals with hydrocephalus generally will require
additional surgeries to replace the shunt, which can be outgrown or become
clogged.
Some individuals with spina bifida require assistive
devices such as braces, crutches, or wheelchairs. The location of the
malformation on the spine often indicates the type of assistive devices needed.
Children with a defect high on the spine and more extensive paralysis will often
require a wheelchair, while those with a defect lower on the spine may be able
to use crutches, bladder catherizations, leg braces, or walkers.
Treatment for paralysis and bladder and bowel problems typically begins soon
after birth, and may include special exercises for the legs and feet to help
prepare the child for walking with braces or crutches when he or she is older.
Next: Can spina bifida be prevented? »
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