Ruptured Myelomenigocele

Myelomeningocele is the most severe form of spina bifida, a congenital neural tube defect in which the spinal cord and its protective coverings (meninges) protrude through an opening in the spine. When this sac becomes ruptured, the protective membrane is torn, and the spinal cord is exposed, leading to high risk of infection, neurological damage, and death if not treated urgently. In Bangladesh, ruptured myelomeningocele remains a critical neonatal emergency, often presenting to tertiary centers within hours or days of birth, especially in rural areas where prenatal diagnosis is limited or unavailable. 🌍 Bangladesh Context: Urgent Pediatric Neurosurgical Need Ruptured myelomeningocele continues to be a major public health concern in Bangladesh, due to: Lack of folic acid supplementation in early pregnancy Low awareness of neural tube defects among expectant mothers Limited access to routine prenatal ultrasonography Delayed or improper referral to pediatric neurosurgeons Many infants born in rural or peripheral health facilities are brought late with already ruptured sacs, exposing them to meningitis, sepsis, and permanent paralysis. At institutions like the National Institute of Neurosciences & Hospital (NINS) and Bangladesh Paediatric Neurocare Centre, Dr. Md. Nafaur Rahman and his team provide timely surgical repair, infection control, and long-term care for affected children. 🚨 Causes and Risk Factors Folic acid deficiency during the first 28 days of pregnancy Genetic predisposition and consanguinity Maternal diabetes, obesity, or use of certain medications during pregnancy Environmental factors such as poor maternal nutrition or exposure to toxins ⚠️ Signs of Ruptured Myelomeningocele A spinal defect, usually in the lower back, with exposed neural tissue Leaking cerebrospinal fluid (CSF) from the site Red, raw, or ulcerated sac Weakness or paralysis in legs Bladder and bowel dysfunction Signs of meningitis: fever, lethargy, irritability Hydrocephalus (enlarged head due to fluid accumulation in the brain), often coexisting 🔬 Diagnosis Clinical examination of the spine defect at birth MRI spine or Ultrasound to evaluate the extent of neural involvement MRI brain to assess for hydrocephalus or Chiari II malformation Laboratory tests for signs of infection or meningitis Prenatal diagnosis (often missed in Bangladesh due to limited antenatal care) 🛠️ Surgical and Postoperative Management Early surgical intervention is critical. Ideally, surgical repair should occur within 24–48 hours of birth or as soon as possible after rupture to prevent central nervous system infection and further neurological deterioration. ✅ Surgical Goals: Close the spinal defect Preserve neural function Prevent infection Manage associated hydrocephalus with VP shunt or ETV 🧠 Postoperative Care: IV antibiotics to prevent/treat meningitis Wound care and pressure sore prevention Monitoring for hydrocephalus or worsening neurological signs Physiotherapy and rehabilitation Urological care for bladder dysfunction 🔄 Long-Term Outcomes Many children with ruptured myelomeningocele will have: Paralysis or weakness in the lower limbs Neurogenic bladder requiring catheterization or surgery Hydrocephalus, which may need shunt revision in future Learning difficulties or developmental delay Risk of spinal deformity or tethered cord syndrome However, with early surgery, multidisciplinary care, and parental education, children can survive and lead functional lives with proper support. 👨‍⚕️ Why Choose Dr. Md. Nafaur Rahman? Leading expert in pediatric spinal birth defect surgery in Bangladesh Successfully managed hundreds of complex myelomeningocele cases, including ruptured presentations Offers complete care: emergency surgery, infection control, hydrocephalus management, and rehabilitation planning Operates at NINS, Bangladesh’s top neurosurgical center Chief Consultant at Bangladesh Paediatric Neurocare Centre, providing integrated care for spina bifida 📞 Contact for Urgent Pediatric Spinal Surgery Dr. Md. Nafaur Rahman Assistant Professor, Department of Pediatric Neurosurgery, NINS Chief Consultant, Bangladesh Paediatric Neurocare Centre 📞 For Appointment/Referral: 01912988182 | 01607033535 🌐 Visit: www.neurosurgeonnafaur.com