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Meningeal hernias are problems that affect children - they can even be recognized during the intrauterine development of a child. There are various forms of them, some of the hernias contain only the meninges of the brain or spine, others may also contain fragments of the spinal cord. Hernias, especially the meningeal hernias, can lead to life-long disorders - luckily, it is possible to reduce the risk of their occurrence in a baby by supplementing the mother with folic acid.

Meningeal herniascan occur both in the skull and in the spine, but in the latter location they are much more common. There are several types of hernia, the division of such hernias depends mainly on the content of the hernial sac.

A hernia is a condition in which there is abnormal tissue movement.

So, there are meningeal hernias (in which only the meninges of the central nervous system are displaced), but alsospinal hernias(containing both the meninges and a fragment of the spinal cord). The inside of the meningeal hernia sac also contains, in addition to the structures already mentioned, the cerebrospinal fluid.

Meningeal hernias: causes

Meningeal hernias are classified as dysraphic defects, i.e. those that arise as a result of disturbances in the closure of the neural tube. When the development of the vertebrae of the spine or the bones of the skull is impaired, a defect occurs in them, through which the structures of the nervous system can move - this is how the meningeal hernia develops. The exact etiopathogenesis of meningeal hernias and other dysraphic defects is unknown. . It is known that their formation occurs around the fourth week of gestation (this is when the neural tube should close properly). Factors that are suspected of influencing the formation of meningeal hernias are:

  • teratogenic substances harmful to the fetus (e.g. antiepileptic drugs, nicotine, alcohol or vitamin A in large amounts)
  • maternal infections (especially viral)
  • genetic load predisposing to congenital neural tube defects
  • nutrient deficiencies (folic acid deficiency is considered particularly important in the pathogenesis of these defects)

Meningeal hernias: symptoms

Sometimes the only symptom of a hernia is simply its presence - this is the case of meningeal hernias, where usually no abnormalities in the nervous system are found, in addition, such a hernia is usually covered with properly built skin. The clinical picture of spinal hernias is much richer. They most often occur in the lumbar or sacral spine. Meningo-spinal hernias are covered with altered, thin skin, sometimes with no skin coverage at all. Due to the displacement of the fragments of the spinal cord lying in this area, paralysis of the lower limbs and sensory disturbances within them, as well as urination disorders (sometimes referred to as the neurogenic bladder) may occur. The consequences of the presence of a meningeal hernia in a child may also include defects in the lower limbs, such as clubfoot or dislocation of the hip joint. In addition to the aforementioned, a common problem that occurs in children with meningeal hernias is hydrocephalus - it is observed in up to 9 out of 10 children with a meningeal hernia.

Meningeal hernias: diagnosis

The existence of a meningeal hernia should be diagnosed during pregnancy. It is possible by ultrasound (dysraphic changes can be detected mainly in the second trimester of pregnancy), but also by assessing the concentration of alpha-fetoprotein - in the case of this marker, in the case of dysraphic defects of the fetus, its concentration increases.

In the postnatal period, diagnosis of the meningeal hernia may be complemented by other tests, such as magnetic resonance imaging.

Sometimes invasive prenatal examinations are performed, such as fetoscopy. Properly early diagnosis is important, especially because the delivery of a child with a meningeal hernia should take place in a center with a high level of reference - usually such a pregnancy is terminated by caesarean section.

Meningeal hernias: treatment

Surgical procedures are the basis for the treatment of meningeal hernias. Sometimes attempts are made to operate while still pregnant, in other cases the procedures are performed at different times after delivery. In a situation where the hernia (especially in the form of the meningeal hernia) is not covered with the skin, the operation can be performed even within the first 24 hours after birth - in this case the procedure isprevent infection of exposed tissues of the nervous system. In the case of coexistence with a hydrocephalic hernia, an additional procedure may be the insertion of a ventricular valve (the purpose of which will be to drain excess cerebrospinal fluid), but the operation does not end the treatment of a meningeal hernia. In addition to the neurosurgeon, the child with the problem in question should also be de alt with by an orthopedist, physiotherapist and urologist. This necessity results from the need to treat changes in the locomotor system (e.g. clubfoot), and also to diagnose early and, if necessary, treat urination disorders. Rehabilitation, in turn, is aimed at obtaining the maximum possible fitness in a child. The earliest possible implementation of these interactions is very important - although some neurological deficiencies may be present in patients born with a meningeal hernia even for the rest of their lives, however, if the child is properly looked after from the moment of birth, it is possible that they will be of a minimal degree.

Important

Meningeal hernias: prevention

Meningeal hernias belong to the so-called neural tube defects. They are disorders that can be prevented - for this purpose, folic acid supplementation is used in women. The recommended dose of this supplement is 0.4 mg per day, most preferably when the patient starts taking folic acid before becoming pregnant. The above-mentioned dosages are for women who are not burdened with an increased risk of a neural tube defect in a child (e.g. related to the presence of this type of problem in the family or earlier birth of a child with such a defect). With increased risk, the recommended dosage of folic acid is higher, 4 mg per day. As mentioned at the beginning, the first weeks of intrauterine life decide whether a child develops a neural tube defect - due to this situation, folic acid supplementation is recommended for patients throughout the first trimester of pregnancy.

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Category:

Neurology