Terminal Myelocystocele

Terminal Myelocystocele (TMC) is a rare congenital spinal cord malformation characterized by a fluid-filled sac at the lower back that contains a dilated central canal of the spinal cord extending into a meningocele. It is typically located at the lumbosacral or sacrococcygeal region, and often presents at birth as a swelling or protrusion on the lower back. In the context of Bangladesh, where public awareness and neonatal spinal screening are limited, TMC cases are often diagnosed late, increasing the risk of permanent neurological damage. Timely diagnosis and surgical intervention are essential to prevent irreversible complications such as paralysis, bladder dysfunction, or orthopedic deformities. 🔍 Clinical Features and Diagnosis Children with Terminal Myelocystocele may present with: A soft, translucent sac or swelling on the lower back Skin covering over the swelling (unlike open spina bifida) Bladder and bowel dysfunction Leg weakness, abnormal gait, or foot deformities Delayed milestones or clumsiness in walking Tethered cord syndrome symptoms In Bangladesh, this condition is sometimes misidentified as a simple cyst, lipoma, or meningocele due to its skin-covered appearance. Delayed referral for pediatric neurosurgical evaluation is a common challenge. 🧪 Diagnostic Tools: MRI of the spine – Essential for detecting the myelocystocele, spinal cord termination, tethering, and associated abnormalities Ultrasound – Useful in neonates before closure of the posterior vertebral arch Urodynamic study – For children presenting with urinary incontinence X-rays – May reveal bony anomalies in the sacral region At NINS and Bangladesh Paediatric Neurocare Centre, Dr. Nafaur Rahman ensures high-quality MRI imaging, early diagnosis, and detailed case evaluation for complex spinal anomalies like TMC. 🧠 Associated Anomalies Terminal Myelocystocele may coexist with: Hydrocephalus Chiari malformation Syringomyelia Split cord malformation Anorectal malformations Urogenital anomalies A multidisciplinary approach is essential, which Dr. Nafaur coordinates across pediatric specialties to ensure the best outcomes in Bangladesh's setting. 🛠️ Surgical Treatment of Terminal Myelocystocele Surgery is the mainstay of treatment and should be performed early—preferably in the first few months of life to prevent deterioration. 🔧 Surgical Objectives: Microsurgical untethering of the spinal cord Resection of the cyst and surrounding meningocele sac Reconstruction of the spinal canal Preservation of functional neural tissue Repair of dural defects to prevent CSF leak “Microsurgical correction of terminal myelocystocele requires extreme precision. In Bangladesh, we are bridging the treatment gap with world-class surgical care for even the rarest spinal conditions.” — Dr. Md. Nafaur Rahman Using advanced intraoperative neuromonitoring (IONM) and microsurgical tools, Dr. Nafaur Rahman has successfully operated on several complex pediatric spinal anomalies with excellent postoperative outcomes. 🏥 Postoperative Care & Follow-up in Bangladesh Following surgery, the child is managed with: Monitoring for wound healing and signs of infection or CSF leak Neurological evaluation for recovery of leg movement and bladder control Regular imaging (MRI) to ensure no retethering or cyst reformation Physiotherapy for muscle strength and mobility Urological support, if bladder issues persist At Bangladesh Paediatric Neurocare Centre, coordinated care is provided with urologists, physiotherapists, and pediatricians under Dr. Nafaur’s leadership. 🌟 Prognosis and Long-term Outlook If diagnosed early and treated appropriately, children with terminal myelocystocele can: Achieve normal or near-normal motor development Regain or retain bladder and bowel control Avoid severe deformities of the spine or limbs Participate in regular schooling and social activities However, late presentation, especially in rural Bangladesh, is linked to poor neurological recovery, highlighting the need for early referral and awareness. Challenges in Bangladesh Despite being a surgically treatable condition, terminal myelocystocele faces multiple challenges in the local healthcare landscape: Low awareness among rural birth attendants and general physicians Misidentification as a benign cyst or swelling Lack of access to pediatric MRI in district hospitals Cultural stigma around birth defects leading to delays in seeking care Limited number of trained pediatric neurosurgeons Dr. Nafaur is at the forefront of addressing these gaps by promoting early newborn screening, medical education, and providing affordable surgical solutions for children across Bangladesh. 👨‍⚕️ Why Choose Dr. Md. Nafaur Rahman? 🧠 Specialist in pediatric spinal cord malformations 🏥 Performs microsurgical correction of terminal myelocystocele with precision 🌐 Works at both NINS and Bangladesh Paediatric Neurocare Centre 🤝 Offers comprehensive, compassionate care from diagnosis to recovery 📈 Excellent track record in improving outcomes for complex neurosurgical cases in children 📞 Contact for Terminal Myelocystocele Surgery in Bangladesh Dr. Md. Nafaur Rahman Assistant Professor, Department of Pediatric Neurosurgery, NINS Chief Consultant, Bangladesh Paediatric Neurocare Centre 📱 For Serial/Appointment: 01912988182 | 01607033535 🌐 Visit: www.neurosurgeonnafaur.com