Abhijeet Yadav

MENINGOMYELOCELE: CASE REPORT WITH ITS EMBRYOLOGICAL BASIS

Neural tube defects affect the tissues overlying the spinal cord: meninges, vertebral arches, muscles, and skin. Birth defects involving the embryonic neural arches are referred to as spina bifida. Spina bifida denotes non fusion of the halves of the embryonic neural arches, which is more common. Severe defects also involve the spinal cord, meninges and neurocranium.1 Meningomyelocele is a congenital disease in which a defect in the embryonal formation of the neural tube leading to malformation of the central nervous system, where parts of the meninges and spinal cord (myelon) emerge from the incompletely closed vertebral arches.2 INTRODUCTION: Spina bifida occurs when the bony vertebral arches fail to form properly, thereby creating a vertebral defect, usually in the lumbosacral region. Spina bifida occulta is evidenced by a tuft of hair in the lumbosacral region. It is the least severe variation and occurs in 10% of the population. Spina bifida with meningocele occurs when the meninges protrude through a vertebral defect and form a sac filled with CSF. The spinal cord remains in its normal position. Spina bifida with meningomyelocele occurs when the meninges and spinal cord protrude through a vertebral defect and form a sac filled with CSF. Spina bifida with rachischisis occurs when the posterior neuropore of the neural tube fails to close during week 4 of development. This condition is the most severe type of spina bifida, causing paralysis from the level of the defect caudally. 3 CASE REPORT: A neonate was brought to the OPD of pediatric surgery of Hamidia Hospital, Bhopal. The patient was full term normal vaginal delivery but with a defect in the thoraco-lumbar region which was present in midline. There was no history of folic acid tablet consumption by the mother. The local examination of the swelling revealed that it was circular to oval in shape with elevated margins and a central defect measuring approx. 9.5 cm × 7.5 cm. There was presence of yellow whitish tissue which resembled neural element. Neurological examination revealed poor reflexes. No other defect was present. The diagnosis of NEURAL TUBE DEFECT most likely meningomyelocele was made.