Non Ruptured Myelomenigocele

Myelomeningocele is a severe form of spina bifida, a congenital neural tube defect where the spinal cord and meninges protrude through a defect in the vertebrae. In a non-ruptured case, the protruded sac is covered by a thin membrane and has not yet torn or leaked cerebrospinal fluid (CSF). This condition is surgically correctable if treated early, and it offers a much better prognosis compared to ruptured cases. A non-ruptured myelomeningocele should be considered a surgical emergency, though not as urgent as a ruptured one. Timely referral and expert surgical intervention can significantly reduce the risks of infection, neurological deterioration, and long-term disability. 🌍 Bangladesh Perspective: A Crucial Window for Intervention In Bangladesh, non-ruptured myelomeningocele often goes undiagnosed during pregnancy due to limited antenatal ultrasonography and lack of folic acid supplementation. Many cases are discovered at birth, especially in rural areas where prenatal screening is unavailable. Parents may not understand the importance of urgent neurosurgical referral, delaying life-saving treatment. At the National Institute of Neurosciences & Hospital (NINS) and the Bangladesh Paediatric Neurocare Centre, Dr. Md. Nafaur Rahman leads a highly skilled team that provides safe surgical repair, prevents rupture, and offers long-term follow-up for these children. ⚠️ Causes and Risk Factors Folic acid deficiency in early pregnancy (first 4 weeks) Genetic predisposition or family history of neural tube defects Poor maternal nutrition or lack of prenatal care Maternal diabetes, certain medications, or infections during pregnancy Environmental toxins or exposure to chemicals during early gestation 🧒 Clinical Features of Non-Ruptured Myelomeningocele A soft, bulging sac on the back (usually in the lower spine) Thin, transparent skin or membrane covering the sac Weakness or paralysis in the legs Abnormal limb movement or clubfoot Bladder and bowel dysfunction Associated hydrocephalus (in up to 80% of cases) Absence of pain or infection (differentiates it from ruptured cases) 🔍 Diagnostic Investigations 🧠 MRI Spine Essential to evaluate the contents of the sac and level of spinal cord involvement 🧠 MRI Brain Detects associated Chiari II malformation, hydrocephalus, and other brain anomalies 🔬 Ultrasound (if MRI is unavailable) Can give basic anatomical details in newborns 🧪 Blood Tests Rule out any signs of infection and assess fitness for surgery 🧬 Antenatal Ultrasound (Prevention) Routine antenatal screening can detect neural tube defects as early as 18–20 weeks gestation 🛠️ Surgical Management Timely surgical closure is the gold standard. Ideally, the operation should be performed within 72 hours of birth to reduce risks of infection, rupture, or neurological decline. ✂️ Surgical Objectives: Close the spinal defect and protect neural elements Preserve as much neurological function as possible Prevent infection and CSF leakage Manage associated hydrocephalus with VP shunt if needed 🧠 Associated Conditions Hydrocephalus – treated with ventriculoperitoneal (VP) shunt Chiari II malformation – may require decompression in severe cases Orthopedic deformities – clubfoot, hip dislocation, scoliosis Bladder and bowel dysfunction – requires urological evaluation and follow-up Tethered spinal cord – a long-term complication requiring surveillance 🔄 Long-Term Care & Multidisciplinary Support Although surgery prevents deterioration, most children need lifelong follow-up and rehabilitation. Dr. Md. Nafaur Rahman offers comprehensive post-surgical care, including: Neurosurgical surveillance for shunt function and tethered cord Urology support for bladder control Physiotherapy for lower limb function and mobility Orthopedic care for bone and joint deformities Developmental assessments and special education Parental counseling and psychological support 👨‍⚕️ Why Choose Dr. Md. Nafaur Rahman? Renowned pediatric neurosurgeon with extensive experience in managing both ruptured and non-ruptured myelomeningocele Operates at NINS, Bangladesh’s premier neurosurgical institute Leads a coordinated team at Bangladesh Paediatric Neurocare Centre for integrated follow-up Trusted by hundreds of families for safe surgery, hydrocephalus management, and long-term neurological care 📞 Contact for Early Intervention and Consultation Dr. Md. Nafaur Rahman Assistant Professor, Pediatric Neurosurgery, National Institute of Neurosciences & Hospital (NINS) Chief Consultant, Bangladesh Paediatric Neurocare Centre 📞 For Serial/Appointment: 01912988182 | 01607033535 🌐 Visit: www.neurosurgeonnafaur.com