Meningocele

Description:

The meningocele - this type of morbid conditions belongs to the front brain hernias caused by inborn deficit of a bone tissue in the field of a bottom of a front cranial pole in the period of embryonic development under the influence of these or that external (infection) and the internal (genetic) reasons therefore there is a delay of a smykaniye of protovertebralny brain plates (Kolliker plate) that leads to formation of openings in the lower wall of a front cranial pole through which prolabirut substance a brain. The specified hernias received the name of front brain hernias. As it was already noted, they are formed by a prolapse at first of the meninx forming the bag filled cerebrospinal fluid and then if an opening rather big — and by an exit in this bag and fabrics by a brain. Usually this prolapse occurs through an opening in the field of a root of a nose and glabella. Brain hernias and a meningocele are divided into two look:

    * (nasofrontal) lying on the average line;
    * lying but to nose root sides (nosoreshetchaty) and in an internal corner of an eye-socket (nosoorbitalny).

Except genetically caused meningoceles, defects of a bone tissue in a front cranial pole (as well as in other parts of a skull) can result from the pre-natal, transplatsentarno transferred from mother infection, a pre-natal or birth trauma, and also at other adverse factors, negatively influencing pases an organism of the pregnant woman. A considerable role is played at the same time by disturbance of metabolism of vitamin A and folic acid, calcic exchange, and also action of ionizing radiation and some teratogenic toxics. Each of the specified pathogenic factors can lead to disturbance of embryonic development in the period of laying of primary brain plate and its short circuit in a brain tube that in the subsequent leads to developing of malformations of a skull.

Meningocele symptoms:

Signs of a meningocele share on subjective and objective. The first concern generally only complaints of parents of the child or adult patient to existence of a tumor in the field of a hernia prolapse. Other complaints, as a rule, do not arise. The sizes of this "tumor" can vary from lentil grain to large apple, imitating sometimes "the second nose". To the touch this formation of a myagkoelastichesky consistence, sometimes his leg goes to depth of a root of a nose. The swelling can synchronously pulse with reductions of heart, at a natuzhivaniye (shout or crying of the child) — to increase, with a pressure upon it — to decrease. These signs demonstrate communication of a tumor with a head cavity.

Accessory sign of front meningoceles and hernias of a brain is deformation of a facial skeleton.

Evolution of process depends on a stage of development of hernia and on the applied treatment. At inkurabalny forms when in a hernial bag there is a considerable part a brain with the vital centers, death can come at the age of 5 — 8 years, it, as a rule, the encephalomeningitis is the reason.

At operational treatment of a meningocele the forecast for life favorable. However, according to foreign statistical data, even at faultlessly carried out operative measure the lethality from secondary complications can reach 10%.

Meningocele reasons:

There are various "theories" of origins of a meningocele.  So, Meckel was a supporter of a hypothesis of skull abortion in the embryonal period therefore there is primary ectopia of a meninx and a brain through primary defects of a skull. Springs explains an origin of brain hernias and a meningocele with the pathological changes of a calvaria which resulted from the encephalomeningitis transferred a fruit in the period of pregnancy. Klein believes that pre-natal hydrocephaly which leads to discrepancy of bones of a skull and its perforation in the field of natural foramens is an origin of a meningocele.

Treatment of the Meningocele:

Inborn hernias a brain are a rare disease, and not all children who were born with such defect are exposed to surgical treatment as a part them perish soon after the birth. Treatment of a meningocele and brain hernias at resectable cases only surgical. Terms of treatment vary depending on many indicators, and resolve an issue of surgical treatment in each case individually taking into account age of the child, a type of hernia, the extent of defect and a swelling, and also taking into account threat of emergence of complications. A part of surgeons hold the opinion that it is necessary to start operation in the first months of life. P. A. Herzen considered that child it is necessary to operate in the first year of life. At hernias it is necessary to operate with a brain at rapid growth of a swelling and danger of complications (an inflammation or a rupture of the thinned fabrics) in the first days after the birth. If conditions allow to apply waiting tactics, then an operative measure should be carried out at the age of 2 — 3 years. At this age apply difficult plastic surgeries with use of bone transplants. Such surgical interventions enter competence of neurosurgeons.