eMedicine Specialties > Neurology > Pediatric Neurology

Neural Tube Defects: Treatment & Medication

Author: George I Jallo, MD, Associate Professor of Neurosurgery, Pediatrics and Oncology, Director, Clinical Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine
Coauthor(s): Tibor Becske, MD, Assistant Professor, Department of Neurology, New York University Medical Center
Contributor Information and Disclosures

Updated: Dec 15, 2008

Treatment

Medical Care

The newborn with an open NTD should be kept warm and the defect covered with a sterile wet saline dressing. The patient should be positioned in the prone position to prevent pressure on the defect.

Surgical Care

  • The newborn with an open NTD should undergo prompt closure of the defect. The closure involves classic neurosurgical techniques.
  • Children with hydrocephalus also should have a ventriculoperitoneal shunt placed at the time of myelomeningocele closure.
  • Patients presenting with symptomatic Chiari malformations (see Media file 3) should undergo suboccipital craniotomy and decompression of the posterior fossa and tonsils.
  • Children with syrinx (see Media files 4-5) need a laminectomy and placement of a syringosubarachnoid stent to divert the CSF out of the central canal.

Consultations

  • Neurosurgeon
  • Urologist
  • Orthopedist
  • Physical therapist

Activity

Activity is limited by the degree of involvement.

More on Neural Tube Defects

Overview: Neural Tube Defects
Differential Diagnoses & Workup: Neural Tube Defects
Treatment & Medication: Neural Tube Defects
Follow-up: Neural Tube Defects
Multimedia: Neural Tube Defects
References

References

  1. Barber RC, Lammer EJ, Shaw GM, et al. The role of folate transport and metabolism in neural tube defect risk. Mol Genet Metab. Jan 1999;66(1):1-9. [Medline].

  2. Copp AJ. Prevention of neural tube defects: vitamins, enzymes and genes. Curr Opin Neurol. Apr 1998;11(2):97-102. [Medline].

  3. Czeizel AE, Dudas I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med. Dec 24 1992;327(26):1832-5. [Medline].

  4. Deacon S. Maternal smoking during pregnancy is associated with a higher risk of non-syndromic orofacial clefts in infants. Evid Based Dent. 2005;6(2):43-4. [Medline].

  5. Dias MS, Li V. Pediatric neurosurgical disease. Pediatr Clin North Am. Dec 1998;45(6):1539-78, x. [Medline].

  6. Dirks PB, Rutka JT. The neurogenetic basis of pediatric neurosurgical conditions. In: Albright L, Pollack I, Adelson D, eds. Principles and Practice of Neurosurgery. New York: Thieme Medical Publishers; 1999:. 23-4.

  7. Drolet B. Birthmarks to worry about. Cutaneous markers of dysraphism. Dermatol Clin. Jul 1998;16(3):447-53. [Medline].

  8. George TM, Fagan LH. Adult tethered cord syndrome in patients with postrepair myelomeningocele: an evidence-based outcome study. J Neurosurg. Mar 2005;102(2 Suppl):150-6. [Medline].

  9. Harris LW, Oakes WJ. Open neural tube defects. In: Tindall GT,Cooper PR, Barrow DL, eds. The Practice of Neurosurgery. Baltimore: Williams & Wilkins; 1996:. 2779-89.

  10. MMWR. Use of dietary supplements containing folic acid among women of childbearing age--United States, 2005. MMWR Morb Mortal Wkly Rep. Sep 30 2005;54(38):955-8. [Medline].

  11. Marks JD, Khoshnood B. Epidemiology of common neurosurgical diseases in the neonate. Neurosurg Clin N Am. Jan 1998;9(1):63-72. [Medline].

  12. Mattsson S, Gladh G. [Children with meningomyelocele become adults!]. Lakartidningen. Sep 12-18 2005;102(37):2566-70. [Medline].

  13. McComb JG. Spinal and cranial neural tube defects. Semin Pediatr Neurol. Sep 1997;4(3):156-66. [Medline].

  14. McComb JG, Chen TC. Closed spinal neural tube defects. In: Tindall GT,Cooper PR, Barrow DL, eds. The Practice of Neurosurgery. Baltimore: Williams & Wilkins; 1996:. 2754-77.

  15. McLone DG. Care of the neonate with a myelomeningocele. Neurosurg Clin N Am. Jan 1998;9(1):111-20. [Medline].

  16. Mills JL, Scott JM, Kirke PN, et al. Homocysteine and neural tube defects. J Nutr. Mar 1996;126(3):756S-760S. [Medline].

  17. O'Rahilly R, Muller F. Neurulation in the normal human embryo. Ciba Found Symp. 1994;181:70-82; discussion 82-9. [Medline].

  18. Tubbs RS, Wellons JC, Blount JP, et al. Transient ventriculoperitoneal shunt dysfunction in children with myelodysplasia and urinary bladder infection. Report of three cases. J Neurosurg. Mar 2005;102(2 Suppl):221-3. [Medline].

  19. Walters J, Ashwal S, Masek T. Anencephaly: where do we now stand?. Semin Neurol. 1997;17(3):249-55. [Medline].

Further Reading

Keywords

neural tube defect, NTD, anencephaly, encephalocele, meningocele, meningomyelocele, craniorachischisis totalis, congenital dermal sinus, spina bifida aperta, cystica, myelomeningocele, meningocele, myeloschisis, congenital dermal sinus, lipomatous malformations, lipomyelomeningoceles, split-cord malformations, diastematomyelia, diplomyelia, caudal agenesis, associated hydrocephalus, Chiari II malformation, neurulation

Contributor Information and Disclosures

Author

George I Jallo, MD, Associate Professor of Neurosurgery, Pediatrics and Oncology, Director, Clinical Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine
George I Jallo, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, and American Society of Pediatric Neurosurgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Tibor Becske, MD, Assistant Professor, Department of Neurology, New York University Medical Center
Tibor Becske, MD is a member of the following medical societies: American Association of Neurological Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Robert Stanley Rust Jr, MD, MA, Thomas E Worrell Jr Professor of Epileptology and Neurology, Co-Director of FE Dreifuss Child Neurology and Epilepsy Clinics, Director, Child Neurology, University of Virginia; Chair-Elect, Child Neurology Section, American Academy of Neurology
Robert Stanley Rust Jr, MD, MA is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, American Neurological Association, Child Neurology Society, International Child Neurology Association, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Kenneth J Mack, MD, PhD, Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic
Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Phi Beta Kappa, and Society for Neuroscience
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD, Assistant Professor, Department of Neurology, Division of Pediatrics, Department of Pediatrics, Oregon Health and Science University; Consulting Staff, Shriners Hospital for Children
Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society
Disclosure: Nothing to disclose.

 
 
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