American Medical Association Family Medical Guide - American Medical Association [177]
Treatment
Defects in the formation of the spinal cord cannot be corrected, and any resulting paralysis is permanent. If your child has spina bifida, the doctor will recommend surgery shortly after birth to cover the spinal cord and close the opening on the child’s back. A CT scan (see page 112) or an MRI (see page 113) of the brain may be necessary to detect any related brain malformation or excessive accumulation of fluid in the brain (hydrocephalus). If your child has hydrocephalus, he or she may need surgery to place a shunt (a small plastic tube) in the brain to drain excess fluid.
Although it usually is not possible to repair the defective spinal nerves, physical therapy can help develop muscles, enabling a child with spina bifida to learn to move around and become mobile with the help of wheelchairs, braces, or walkers. For your child to develop to his or her full potential, seek treatment at a children’s hospital that has doctors who specialize in neurosurgery and neural tube defects. Many children with spina bifida can attend school in regular classrooms.
In some cases, surgery is recommended to correct deformities of the legs. Some children with spina bifida are able to achieve bladder control with toilet training. If not, the doctor will show you how to place a catheter through your child’s urethra into his or her bladder to drain urine. You will need to do this four or five times a day. Treatment with antibiotics may be recommended to reduce the risk of urinary tract infections. If your child has bowel problems, the doctor will recommend a high-fiber diet and may prescribe enemas or laxatives to help your child have regular bowel movements. A neurosurgeon and a urologist should see your child regularly to monitor the effectiveness of the treatment.
Spina bifida
In a normal spine (left), the spinal cord is protected by the spinal column. In spina bifida, the spine fails to develop completely, leaving part of the spinal cord exposed. In a form of spina bifida called meningocele (right), a bulging sac containing the meninges (the membranes covering the spinal cord) is visible on an infant’s back. The sac may be covered by skin.
Hydrocephalus
Cerebrospinal fluid is a fluid inside the brain and around the brain and spinal cord. This fluid is produced by the brain and passes into the space around the brain, where it is absorbed into a membrane surrounding the space. If too much fluid is produced, if the membrane is abnormal in a developing fetus, or if the flow of cerebrospinal fluid is blocked, the fluid builds up in the cavities of the brain. This fluid buildup can put pressure on the brain, which can cause the brain to swell, spreading apart the loosely connected bones of the skull and causing the child’s head to become larger than normal.
Hydrocephalus sometimes occurs with spina bifida (see page 398). In premature infants, hydrocephalus can occur from bleeding in the brain. If hydrocephalus is well advanced at birth, the brain can be damaged severely, limiting a child’s physical and mental development and, in some cases, resulting in death. Hydrocephalus can occur later in infancy as a result of damage to the brain from an infection or a tumor.
Symptoms
A doctor may suspect that a newborn has hydrocephalus if the circumference of his or her head is significantly larger than average for his or her overall size or if the head is growing too rapidly. If the doctor suspects hydrocephalus, he or she will measure the baby’s head periodically. If the rate of growth of the head is greater than normal for the baby’s age and size, the doctor probably will order an ultrasound scan (see page 111), an MRI (see page 113), or a CT scan (see page 112) to help make a diagnosis.
Treatment
Hydrocephalus is treated surgically. The infant is given general anesthesia, and the surgeon drills a small hole in the infant’s skull. The doctor inserts a tube with a one-way valve into the hole, extending it into the ventricle (a natural space in the brain). He or she then inserts the other