The passage continues a discussion of ventricular dilatation and then describes myelomeningocele, its associated findings, and recurrence prevention.
Assessment of ventricular dilatation
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A very large head, widely open sutures and fontanels, or head circumference increasing by more than 1 cm in a fortnight during the first three months should raise suspicion.
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CT or MRI confirms the diagnosis, and the pattern of ventricular dilatation indicates the site of obstruction.
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Isolated aqueductal stenosis has a better prognosis.
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Management seeks a specific cause and may include a ventriculocaval or ventriculoperitoneal shunt to decompress the brain.
Myelomeningocele: structure and associated findings
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Myelomeningocele presents as a membranous lumbosacral protrusion containing meninges, cerebrospinal fluid, nerve roots, and a dysplastic spinal cord.
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The defect is open and lacks skin covering; meningocele is covered with skin.
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Arnold-Chiari malformation and congenital hydrocephalus are often associated.
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Neurological deficits may be absent, but severe motor and sensory deficits are common, and urinary and fecal incontinence are usually present.
Surgery and recurrence prevention
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The source states that meningomyelocele is operated on only when lower-limb paralysis and bladder or bowel involvement are absent.
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Folic acid at 4 mg/day is advised during the periconceptional period to prevent recurrence.