Neural Tube Defects Treatment & Management

  • Author: George I Jallo, MD; Chief Editor: Amy Kao, MD   more...
 
Updated: Mar 22, 2011
 

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.[15]

Next

Surgical Care

  • The newborn with an open NTD should undergo prompt closure of the defect. The closure involves classic neurosurgical techniques.[15]
  • Children with hydrocephalus also should have a ventriculoperitoneal shunt placed at the time of myelomeningocele closure.
  • Patients presenting with symptomatic Chiari malformations (refer to image below) should undergo suboccipital craniotomy and decompression of the posterior fossa and tonsils. Child with Chiari malformation, in whom the tonsilChild with Chiari malformation, in whom the tonsils have descended to the level of C2.
  • Children with syrinx (see the following images) need a laminectomy and placement of a syringosubarachnoid stent to divert the CSF out of the central canal. MRI of a cervical syrinx in the sagittal plane. MRI of a cervical syrinx in the sagittal plane. MRI of a cervical syrinx in the axial plane. MRI of a cervical syrinx in the axial plane.
Previous
Next

Consultations

  • Neurosurgeon
  • Urologist
  • Orthopedist
  • Physical therapist
Previous
Next

Activity

Activity is limited by the degree of involvement.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

George I Jallo, MD  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 Medical Association, and American Society of Pediatric Neurosurgeons

Disclosure: Codman (Johnson & Johnson) Grant/research funds Consulting; Medtronic Grant/research funds Consulting

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

Chief Editor

Amy Kao, MD  Attending Neurologist, Children's National Medical Center, Washington DC

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.

References

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

  2. 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.

  3. 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.

  4. 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.

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

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

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

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

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

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

  11. 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].

  12. 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].

  13. 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].

  14. Jentink J, Dolk H, Loane MA, et al. Intrauterine exposure to carbamazepine and specific congenital malformations: systematic review and case-control study. BMJ. Dec 2 2010;341:c6581. [Medline]. [Full Text].

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

  16. 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].

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

  18. 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].

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

  20. 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].

 
Previous
Next
 
Myelomeningocele in a newborn.
Myelomeningocele in a newborn - Lateral view.
Child with Chiari malformation, in whom the tonsils have descended to the level of C2.
MRI of a cervical syrinx in the sagittal plane.
MRI of a cervical syrinx in the axial plane.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.