Meningocele vs Myelomeningocele

This is table showing the difference between Meningocele vs Myelomeningocele. 

 

 

MyelomeningoceleDefinitionIt is type of spina bifida cystica characterized by the herniation of spinal cord contents and meninges through an abnormal defect in the back bone [1].

Incidence

It is the most common type of spina bifida. It can affect as many as 1 out of every 800 babies. It is only present along the spinal cord [2].

 

Location

Though it can be present at any site along the spinal cord the lumbosacral area is the most common location of myelomeningocele. It is not located in the skull [3].

Types

It can be classified into various types depending upon the location. These are:

  • Thoracic myelomeningocele
  • Lumber myelomeningocele
  • Sacral myelomeningocele
  • Anterior myelomeningocele
  • Posterior myelomeningocele
  • Lateral myelomeningocele [3]

 

 

 

Clinical features

It can present as a cystic swelling in the lower back. As this sac consists of both meninges and spinal cord contents there is always a chance of injury to the spinal nerves and spinal cord contents. Therefore, it is classed as a severe form of spina bifida. The patient having myelomeningocele can present with following signs and symptoms:

  • Urinary frequency, urgency and incontinence
  • Urinary retention
  • Constipation and diarrhea
  • An allergy to latex
  • Scoliosis
  • Hydrocephalus (in 90% of cases)
  • Difficulty in walking
  • Poor coordination in walking
  • Paralysis of lower limbs
  • Numbness of lower limbs
  • Pain and heaviness in lower limbs
  • Loss of sensation in peri-anal and genital area [3,4]

 

Diagnosis

Myelomeningocele can be diagnosed on physical examination of the lower back of a baby just after birth. In doubtful conditions, the following investigations can be carried out to diagnose myelomeningocele:

  • X-Rays- spine
  • MRI-spine

Prenatally it can be diagnosed by following screening tests, though these are non-specific:

  • Serum Alpha Fetoprotein levels
  • Quadruple/triple screen
  • Ultrasonography
  • Amniocentesis [5]

 

Treatment

Surgical repair is the treatment of choice. Surgery can be performed before or after birth. The results of prenatal surgery are far better than those of the post-natal procedures. Two types of prenatal repair can be performed. These include:

After birth repair surgery is carried out to put  the sac contents back into the spinal cord [3]

 

 

Conclusion

Myelomeningocele is the most common and the most severe form of spina bifida. If not properly treated in early infancy it can lead to irreversible deficits.

MeningoceleDefinitionIt is also a type of spina bifida cystica characterized by the herniation of meninges through an abnormal opening in the back bone or skull [8].

Incidence

It is the rare form of neural tube defect and occurs at a rate of one per 5000 live births worldwide. It is present both along the spinal cord and skull [9].

 

Location

It may be present in the skull as well as along the length of spinal cord. The posterior midline of the skull is the most common location in the skull. In spinal cord it is most commonly located in the lumbosacral area [10].

Types

It can be classified into different types depending upon its location:

  • Occipital meningocele
  • Frontoethmoidal meningocele
  • Nasofrontal meningocele
  • Nasoorbital meningocele
  • Encephalomeningocele
  • Sacral meningocele
  • Thoracic meningocele
  • Lumber meningocele [10,11].

 

Clinical features

It can present as a cystic swelling in the skull or along the back bone. In the skull, it may present on the posterior midline, between nose and forehead, and between forehead and ethmoidal bone. As the contents of meningocele do not contain the spinal cord or its nerves chances of spinal cord injury are rare. Cranial meningocele can cause severe complications especially if some part of brain tissue is also present. The clinical features of meningocele may include:

  • Development of hydrocephalous- characterized by macrocephaly, headache, vomiting, urinary incontinence
  • Spastic weakness of all four limbs
  • An abnormally small sized head
  • Uncoordinated muscle movements
  • Delayed developmental milestones
  • Vision problems
  • Mental and growth retardation.
  • Seizures [12,13]

 

 

Diagnosis

Meningocele can be detected by just examining the skull and back of a baby after delivery. In some situations the following tests are carried out to detect meningocele:

  • X-Rays- spine and skull
  • MRI-spine and skull

Prenatally it can be diagnosed by following screening tests, though these are non-specific:

  • Serum Alpha Fetoprotein levels
  • Quadruple/triple screen
  • Ultrasonography
  • Amniocentesis [5]

 

Treatment

The only treatment for meningocele is surgical repair which can be carried out before or after the delivery of baby. Prenatal surgical options to close meningocele include:

  • Open prenatal fetal surgery
  • Minimal invasive surgery [6,7]

 

After birth, different options are available for surgical repair. An endoscopic endonasal approach is a minimally invasive procedure that is a good choice to close the meningocele. Open repairs can also be performed [3]

 

Conclusion

Meningocele is a rare and less severe form of spina bifida. Surgical repair is necessary to prevent complications. Neurological deficits are rare.

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References

  1. Copp AJ, Stanier P, Greene ND. Neural tube defects: recent advances, unsolved questions, and controversies. Lancet Neurol 2013;12(8):799-810.
  2. Persad VL,Hof M, Dube JM,Zimmer P. Incidence of open neural tube defects in Nova Scotia after folic acid fortification. CMAJ 2002; 167(3): 241-5.
  3. Myelomeningocele [Internet]. [Last updated 15 Mar 2004; Cited on 30 Oct 2013]. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002525/.
  4. Saboval L,Horn F, Drdulova T, et al. [Clinical condition of patients with neural tube defects]. Rozhl Chir 2010;89(8):471-7.
  5. Birnbacher R, Messerschmidt AM, Pollak AP. Diagnosis and prevention of neural tube defects. Curr Opin Urol 2002;12(6):461-4.
  6. Deprest JA, Devlieger R, Srisupundit K, et al. Fetal surgery is a clinical reality. Semen Fetal Neonatal Med 2010;15(1):58-67.
  7. Bui TH, Deprest JA, Ville Y, Westgren M. Minimally invasive techniques make fetal surgery possible. Disabling abnormalities can be corrected. Lakartidningen 1998;95(44):4848-50, 4853-4.
  8. Shallow TA. SPINA BIFIDA AND CRANIAL MENINGOCELE. Ann Surg 1928; 87(6): 811–822
  9. Laurence KM, Tew BJ. Natural History of Spina Bifida Cystica and Cranium Bifidum Cysticum. Arch Dis Child 1971; 46(246): 127-38.
  10. Manning SM, Jennings R, Madsen JR. Pathophysiology, prevention, and potential treatment of neural tube defects. Ment Retard Dev Disabil Res Rev 2000;6(1):6-14.
  11. Simpson DA ,David DJ, White J. Cephaloceles: treatment, outcome, and antenatal diagnosis. Neurosurgery 1984;15(1):14-21..
  12. Imbruglia L, Cacciatore A, Carrara S. Abnormal skull findings in neural tube defects. J Prenat Med 2009; 3(3): 44-7.
  13. McComb  JG. Spinal and cranial neural tube defects. Semin Pediatr Neurol 1997;4(3):156-66.