Posterior Cervix

Figure 3.64. This infant has a thoracic myelo-meningocele which presents as an open midline defect. Although myelomeningoceles occur most commonly at the lumbosacral level, they may affect the neural tube at any level. The posterior elements covering the spinal canal fail to form, but in this type of defect the cystic mass that bulges out posteriorly contains neural tissue and the surface of the meninges is exposed to the exterior with no skin covering. Large lesions may incorporate a large segment of the spinal cord itself.

Leaking Cervix Pics

Figure 3.65. Thoracolumbosacral myelo-meningocele with exposure of the central spinal canal. Note the leaking of cerebrospinal fluid. The meningeal sac often ruptures before birth or during delivery, thus exposing the neural tissue to direct injury or the risk of infection. Loss of neurologic function distal to the lesion is the rule. There may be absence of control of the urinary and anal sphincters, bladder paralysis, and variable degrees of sensory and motor deficit to the lower limbs.

3.65

Figure 3.65. Thoracolumbosacral myelo-meningocele with exposure of the central spinal canal. Note the leaking of cerebrospinal fluid. The meningeal sac often ruptures before birth or during delivery, thus exposing the neural tissue to direct injury or the risk of infection. Loss of neurologic function distal to the lesion is the rule. There may be absence of control of the urinary and anal sphincters, bladder paralysis, and variable degrees of sensory and motor deficit to the lower limbs.

Figure 3.66. A close-up view of the thoracolumbosacral myelomeningocele with the exposed central canal visible.

Infant Cervix

3.66

Figure 3.67. In this infant with a lum-bosacral myelomeningocele note that with this low level of involvement, there was no anal wink, the hips were flexed, and there were bilateral clubfeet. Clubfeet and rockerbottom feet are commonly associated with myelomeningoceles.

Figure 3.67. In this infant with a lum-bosacral myelomeningocele note that with this low level of involvement, there was no anal wink, the hips were flexed, and there were bilateral clubfeet. Clubfeet and rockerbottom feet are commonly associated with myelomeningoceles.

Figure 3.68. In this infant with a lumbosacral meningocele note that the sac is closed and that there is an overlying hair tuft. Trivial abnormalities such as nevi, sinuses, and hair tufts may indicate an underlying central nervous system abnormality.

Figure 3.69. An infant with rachischisis or myelomeningocele. In contrast to encephaloceles, myelomeningoceles represent failure of closure of the posterior neuropore. There is usually lack of fusion of the vertebral arches with broadened vertebrae and dorsal protrusion of the neural tissue in an enclosed sac with a thin membrane that can easily rupture. Secondary hydrocephalus is a common association.

Very Posterior Cervix

with protrusion of the cervix). Procidentia is a very uncom-Figure 3.70. Thoracolumbar myelo- mon finding in the neonate but, if present, is invariably meningocele in another infant. associated with a neural tube defect.

Diastematomyelia (congenital medial cleft of the spinal cord) is usually associated with spina bifida occulta. There may be tufts of hair (hypertrichosis) in the area of the mid to lower thoracic spinal column. The condition is diagnosed by MRI.

Tuft Hair Spina Bifida
Figure 3.73. Posterior view of the same infant as in Figure 3.72 showing the lumbar myelomeningocele.

Figure 3.74. A 31-week gestation premature infant with a cloacal exstrophy sequence (exstrophy of the cloaca, imperforate anus, ambiguous genitalia, and myelocystocele). There is a myelocystocele (hydro-myelia; syringomyelocele) extending from T7 to the sacrum, and the infant also had an associated Arnold-Chiari malformation.

Myelocystoceles are due to dilatation of the central canal (hydromyelia) and to protrusion over the surface of the posterior aspect of the much expanded spinal cord which may be covered by meninges and skin. In such cases, the cavity is cranially and caudally directly connected with the central canal. The spinal nerves do not traverse the cavity (as they do in the common myelomeningocele) but course around it.

Figure 3.74. A 31-week gestation premature infant with a cloacal exstrophy sequence (exstrophy of the cloaca, imperforate anus, ambiguous genitalia, and myelocystocele). There is a myelocystocele (hydro-myelia; syringomyelocele) extending from T7 to the sacrum, and the infant also had an associated Arnold-Chiari malformation.

Myelocystoceles are due to dilatation of the central canal (hydromyelia) and to protrusion over the surface of the posterior aspect of the much expanded spinal cord which may be covered by meninges and skin. In such cases, the cavity is cranially and caudally directly connected with the central canal. The spinal nerves do not traverse the cavity (as they do in the common myelomeningocele) but course around it.

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