Meningomyelocele, myelocele/myeloschisis, open spinal dysraphism, spina bifida aperta
Definitions
Myelomeningocele (MMC): Open (lacking skin covering) spinal dysraphism in which neural placode (exposed flattened end of elongated spinal cord) protrudes as sac beyond skin surface dorsal to spinal canal
Myelocele (MC): Open spinal dysraphism with neural placode flush with skin surface or in spinal canal (no sac)
Some authors refer to all open spinal dysraphisms as MMC (as MMC & MC fall along same pathologic spectrum)
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Khalaveh F et al: Myelomeningocele-Chiari II malformation-neurological predictability based on fetal and postnatal magnetic resonance imaging. Prenat Diagn. 41(8):922-32, 2021
Licci M et al: CSF shunting in myelomeningocele-related hydrocephalus and the role of prenatal imaging. Childs Nerv Syst. ePub, 2021
Yuan W et al: Diffusion tensor imaging in children following prenatal myelomeningocele repair and its predictive value for the need and timing of subsequent CSF diversion surgery for hydrocephalus. J Neurosurg Pediatr. 1-9, 2021
Nagaraj UD et al: Imaging of open spinal dysraphisms in the era of prenatal surgery. Pediatr Radiol. 50(13):1988-98, 2020
Nagaraj UD et al: Myelomeningocele versus myelocele on fetal MR images: are there differences in brain findings? AJR Am J Roentgenol. 211(6):1376-80, 2018
Barkovich AJ et al: Pediatric Neuroimaging. 6th ed. Wolters Kluwer. 979-82, 2019
Nagaraj UD et al: Spinal imaging findings of open spinal dysraphisms on fetal and postnatal MRI. AJNR Am J Neuroradiol. 39(10):1947-52, 2018
Nagaraj UD et al: Hindbrain herniation in Chiari II malformation on fetal and postnatal MRI. AJNR Am J Neuroradiol. 38(5):1031-6, 2017
Caldarelli M et al: Recurrent tethered cord: radiological investigation and management. Childs Nerv Syst. 29(9):1601-9, 2013
Messing-Jünger M et al: Primary and secondary management of the Chiari II malformation in children with myelomeningocele. Childs Nerv Syst. 29(9):1553-62, 2013
Sweeney KJ et al: Spinal level of myelomeningocele lesion as a contributing factor in posterior fossa volume, intracranial cerebellar volume, and cerebellar ectopia. J Neurosurg Pediatr. 11(2):154-9, 2013
Jernigan SC et al: Risk factors of sudden death in young adult patients with myelomeningocele. J Neurosurg Pediatr. 9(2):149-55, 2012
Adzick NS et al: A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med. 364(11):993-1004, 2011
Chao TT et al: Fetal spine findings on MRI and associated outcomes in children with open neural tube defects. AJR Am J Roentgenol. 197(5):W956-61, 2011
Rufener SL et al: Congenital spine and spinal cord malformations--pictorial review. AJR Am J Roentgenol. 194(3 Suppl):S26-37, 2010
Hirose S et al: Fetal surgery for myelomeningocele. Clin Perinatol. 36(2):431-8, xi, 2009
Hirose S et al: Fetal surgery for myelomeningocele: panacea or peril? World J Surg. 27(1):87-94, 2003
Johnson MP et al: Fetal myelomeningocele repair: short-term clinical outcomes. Am J Obstet Gynecol. 189(2):482-7, 2003
Ertl-Wagner B et al: Fetal magnetic resonance imaging: indications, technique, anatomical considerations and a review of fetal abnormalities. Eur Radiol. 12(8):1931-40, 2002
Rintoul NE et al: A new look at myelomeningoceles: functional level, vertebral level, shunting, and the implications for fetal intervention. Pediatrics. 109(3):409-13, 2002
Trivedi J et al: Clinical and radiographic predictors of scoliosis in patients with myelomeningocele. J Bone Joint Surg Am. 84-A(8):1389-94, 2002
Bowman RM et al: Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg. 34(3):114-20, 2001
Tortori-Donati P et al: Spinal dysraphism: a review of neuroradiological features with embryological correlations and proposal for a new classification. Neuroradiology. 42(7):471-91, 2000
Unsinn KM et al: US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases. Radiographics. 20(4):923-38, 2000
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References
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KEY FACTS
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Imaging
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TERMINOLOGY
Synonyms
Meningomyelocele, myelocele/myeloschisis, open spinal dysraphism, spina bifida aperta
Definitions
Myelomeningocele (MMC): Open (lacking skin covering) spinal dysraphism in which neural placode (exposed flattened end of elongated spinal cord) protrudes as sac beyond skin surface dorsal to spinal canal
Myelocele (MC): Open spinal dysraphism with neural placode flush with skin surface or in spinal canal (no sac)
Some authors refer to all open spinal dysraphisms as MMC (as MMC & MC fall along same pathologic spectrum)
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Khalaveh F et al: Myelomeningocele-Chiari II malformation-neurological predictability based on fetal and postnatal magnetic resonance imaging. Prenat Diagn. 41(8):922-32, 2021
Licci M et al: CSF shunting in myelomeningocele-related hydrocephalus and the role of prenatal imaging. Childs Nerv Syst. ePub, 2021
Yuan W et al: Diffusion tensor imaging in children following prenatal myelomeningocele repair and its predictive value for the need and timing of subsequent CSF diversion surgery for hydrocephalus. J Neurosurg Pediatr. 1-9, 2021
Nagaraj UD et al: Imaging of open spinal dysraphisms in the era of prenatal surgery. Pediatr Radiol. 50(13):1988-98, 2020
Nagaraj UD et al: Myelomeningocele versus myelocele on fetal MR images: are there differences in brain findings? AJR Am J Roentgenol. 211(6):1376-80, 2018
Barkovich AJ et al: Pediatric Neuroimaging. 6th ed. Wolters Kluwer. 979-82, 2019
Nagaraj UD et al: Spinal imaging findings of open spinal dysraphisms on fetal and postnatal MRI. AJNR Am J Neuroradiol. 39(10):1947-52, 2018
Nagaraj UD et al: Hindbrain herniation in Chiari II malformation on fetal and postnatal MRI. AJNR Am J Neuroradiol. 38(5):1031-6, 2017
Caldarelli M et al: Recurrent tethered cord: radiological investigation and management. Childs Nerv Syst. 29(9):1601-9, 2013
Messing-Jünger M et al: Primary and secondary management of the Chiari II malformation in children with myelomeningocele. Childs Nerv Syst. 29(9):1553-62, 2013
Sweeney KJ et al: Spinal level of myelomeningocele lesion as a contributing factor in posterior fossa volume, intracranial cerebellar volume, and cerebellar ectopia. J Neurosurg Pediatr. 11(2):154-9, 2013
Jernigan SC et al: Risk factors of sudden death in young adult patients with myelomeningocele. J Neurosurg Pediatr. 9(2):149-55, 2012
Adzick NS et al: A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med. 364(11):993-1004, 2011
Chao TT et al: Fetal spine findings on MRI and associated outcomes in children with open neural tube defects. AJR Am J Roentgenol. 197(5):W956-61, 2011
Rufener SL et al: Congenital spine and spinal cord malformations--pictorial review. AJR Am J Roentgenol. 194(3 Suppl):S26-37, 2010
Hirose S et al: Fetal surgery for myelomeningocele. Clin Perinatol. 36(2):431-8, xi, 2009
Hirose S et al: Fetal surgery for myelomeningocele: panacea or peril? World J Surg. 27(1):87-94, 2003
Johnson MP et al: Fetal myelomeningocele repair: short-term clinical outcomes. Am J Obstet Gynecol. 189(2):482-7, 2003
Ertl-Wagner B et al: Fetal magnetic resonance imaging: indications, technique, anatomical considerations and a review of fetal abnormalities. Eur Radiol. 12(8):1931-40, 2002
Rintoul NE et al: A new look at myelomeningoceles: functional level, vertebral level, shunting, and the implications for fetal intervention. Pediatrics. 109(3):409-13, 2002
Trivedi J et al: Clinical and radiographic predictors of scoliosis in patients with myelomeningocele. J Bone Joint Surg Am. 84-A(8):1389-94, 2002
Bowman RM et al: Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg. 34(3):114-20, 2001
Tortori-Donati P et al: Spinal dysraphism: a review of neuroradiological features with embryological correlations and proposal for a new classification. Neuroradiology. 42(7):471-91, 2000
Unsinn KM et al: US of the spinal cord in newborns: spectrum of normal findings, variants, congenital anomalies, and acquired diseases. Radiographics. 20(4):923-38, 2000
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