1. Posterior Meningocele

• most common type of meningocele
• hernia contains no neural tissue
• projects externally through a defect in the posterior aspect of the vertebral arch
• usually covered by a thick -> thin layer of skin or membrane
• may or may not leak CSF
• usually not associated with any neurologic deficiencies

2. Anterior Meningocele

• uncommon type of meningocele
• hernia contains no neural tissue
• projects internally through a defect in the anterior aspect of the vertebrae into the pelvis
• complications include:
  • constipation and/or bladder dysfunction
  • females may have associated anomalies of the GU tract
    • retrovaginal fistula
    • vaginal septa

1. Meningocele

• a fluid-filled midline mass that may transilluminate
• usually in the lumbar region but also in the cervical region
• covered with skin or membrane:
  • skin-covered
    • found along the neuroaxis
    • usually free of the associated anomalies
  • membrane-covered
    • usually found rostrally
    • more likely to be associated with anomalies

2. Complications

• these depend on the level and severity of the lesion
• bladder and bowel sphincter dysfunction
• orthopedic problems:
  • equinovarus deformity, club foot, gait disturbances

1. Imaging Studies

2. Prenatal Diagnosis

• elevated maternal serum alpha-feto-protein (AFP)
• level II ultrasound
• amniocentesis - elevated AFP and acetylcholinesterase

1. Surgery

• correction to prevent infection
• immediate if membrane covered +/- CSF leak

2. Supportive

• bowel and bladder problems
• orthopedic problems
• genetic counselling

3. Prevention

• women in the child-bearing years should be encouraged to eat foods rich in folic acid (orange juice, broccoli, whole grains, beans, peanut butter, spinach, peas)
• women who plan to become pregnant should take a supplement of 0.4 mg of folic acid daily
• decrease recurrence rate in patients at risk with 4 mg of folic acid daily from the time of conception through the first trimester