MYELOMENINGOCELE
Myelomeningocele is a congenital malformation due to incomplete closure of the bone and/or soft tissue around the brain or spinal cord. A sack bulges out through the defect like a hernia. If the sack contains neural tissue -brain or spinal cord tissue- it is called a myelomeningocele. If it only contains cerebrospinal fluid it is called a meningocele.
The sack may be exposed completely, or covered by a thin layer of skin. The skin -if present - is of inferior quality and breaks down easily, causing an overwhelming and ever present risk of severe and often fatal infection of the underlying neural content (brain or spinal cord).
The malformation situated in the spine may cause paralysis of both legs, as well as incontinence of urine and feces (stool). For the family and the individual with such a severe handicap, life would be an intolerable disaster due to the absolute non existence of any supportive treatment or assistance. Therefore we follow a policy which was generally accepted in the western world some 50 years ago: leaving the condition untreated. It is considered unethical to let a poor family pay for - and to expose the child to – a surgical treatment that would not have the least effect on the severe disability.
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Mother and child with a lumbar meningocele |
Skin coverage is incomplete and infected. The legs are paralyzed |
Note the paralyzed legs and pouting anus - a sign of anal incontinence |
The surgery involves in principle excision of the sack while preserving eventual content of neural tissue (brain – nerves - spinal cord) followed by a sound closure of the overlying soft tissues. Surgery for a meningocele is naturally much less a challenge compared to surgery for a myelomeningocele. Surgical fee is 3-400 birr (20-30 €)
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Lumbar meningocele |
Lumbar meningocele |
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Meningocele sack exposed |
Meningocele sack excised, closed and covered with soft tissue |
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Undermining the skin to facillitate wound closure |
Wound closure completed |
As the risk of developing hydrocephalus (see page HYDRCEPHALUS) after surgical correction of a spinal myelomeningocele, the circumference of the head has to be measured and followed closely. We do not use shunt insertion as a routine.
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Mother and child with occipital meningocele |
Occipital meningocele |
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Occipital meningocele prepared for surgery |
Meningocele sack exposed |
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Meningocele sack isolated |
Meningocele sack exccised and closed |
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Skin closure completed |
Mother and child after surgery |
The malformation is believed to be caused by lack of Folic Acid. At least the use of supplementary Folic Acid intake during pregnancy reduces the risk of having a child with this malformation radically. “Rafu” is a common and very delicious local dish made of green spinach-like leaves containing high doses of Folic Acid. Unfortunately the active substance is destroyed while boiling the green leaves during preparation of the dish. The leaves taste good even fresh, but it will be a tremendous challenge persuading people to consume uncooked leaves. The Ethiopians generally have extremely conservative food habits.
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Rafu is served for dinner |
With Budena (Injera) bread |
We are aware that intake of Folic Acid in high doses, starting at the very moment of conception, will reduce the risk of having a child with myelomeningocele for a woman who previously gave birth to a child with such a defect, near to zero. However that practice is not applicative out here in the far countryside.