Myelomeningocele Primary Repair Surgical Technique

  • Massimo Caldarelli
  • Concezio Di Rocco


A clear understanding of the pathologic anatomy of the spinal malformation is a fundamental prerequisite of the pre-operative work-up in spina bifida patients [1]. The malformed spinal cord or primitive neural plaque (placode) presents as a flat tongue of neural tissue with its borders merging into the contiguous malformed meningeal coverings. As an effect of the failed neurulation process, both ventral and dorsal spinal roots exit from the ventral aspect of the placode, the dorsal roots exiting laterally to the ventral ones, and corresponding to the boundary between the placode and the arachnoid membrane (junctional zone). The presence of an intact subarachnoid space ventral to the placode confirms the lesion as a myelomeningocele (MMC) (Fig. 10.1), whereas its absence confirms it to be a myelocele, which more closely resembles the deranged anatomy of failed neurulation (Fig. 10.2).
Fig. 10.1 a, b.

Clinical appearance of a lumbar myelomeningocele (a) and schematic drawing (b)of the malformation, demonstrating the relationship of the placode with the subarachnoid space and cutaneous layers, and the exit and course of the spinal roots within the malformed sac


Junctional Zone Dural Closure Cutaneous Layer Split Cord Malformation Fascial Flap 
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Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Massimo Caldarelli
    • 1
  • Concezio Di Rocco
    • 1
  1. 1.Department of Pediatric Neurosurgery and Centre for Spina BifidaCatholic University Medical SchoolRomeItaly

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