Spina bifida and neural tube defects

Question 1

What is the cause of spina bifida and other neural tube defects?

Answer 1

Abnormal neurulation during the first 4 weeks of embryogenesis

They are caused by interaction of genetic and environmental factors.

Preventable with maternal folate supplementation or fortification.

Question 2

What is the most common area for neural tube defects?

Answer 2

Lumbosacral region

Question 3

What is myelomeningocele?

Answer 3

The spinal cord and the meninges are exposed

Question 4

What is meningocele?

Answer 4

Only meninges are exposed

Question 5

What are types of closed spina bifida?

Answer 5

Includes fatty tumours within the spine (lipomeningocele) or intraspinal cartilage or bone (diastematomyelia).

Question 6

What are the two most common neural tube defects?

Answer 6

Anencephaly, which affects brain and skull development and is incompatible with life, and spina bifida, which means ‘split spine’

Question 7

How does spina bifida present?

Answer 7

Variable paralysis and sensory loss in the legs, orthopaedic deformities, neurogenic bowel and bladder, hydrocephalus, and Chiari II malformation

Question 8

What are diagnostic investigations for spina bifida?

Answer 8

1. antenatal triple/quadruple test
2. antenatal ultrasound
3. fetal MRI
4. cranial ultrasound

Question 9

What are risk factors for neural tube defects?

Answer 9

1. Inadequate maternal folate intake
2. Previous pregnancy affected by spina bifida or other neural tube defect
3. Maternal history of spina bifida or other neural tube defect
4. Hispanic ancestry or ethnicity

Question 10

How would you manage spina bifida?

Answer 10

Neurosurgical repair

Neonates born with severe hydrocephalus have a ventriculoperitoneal shunt placed concurrently