Prenatally, open spina bifida can be diagnosed by finding elevated -fetoprotein levels in maternal serum and in amniotic fluid. Ultrasound can show bony spinal defects and soft tissue masses. Prognosis is determined by the number and severity of abnormalities and is poorest for patients with total paralysis below the lesion, kyphosis, hydrocephalus, early hydronephrosis, and associated congenital defects. With proper care, however, many children do well. Loss of renal function and shunt complications are the usual causes of death in older patients with spina bifida.
Treatment requires a united effort by specialists from several disciplines.
Initially important are neurosurgical, urologic, orthopedic, pediatric, and social service evaluations. Thorough evaluation of the infant and counseling of the family should generally precede intervention. Once evaluation is complete, a decision can be made on how aggressive treatment should be. If the defect is leaking CSF, antibiotics and urgent neurosurgical evaluation and repair will reduce the risk of meningeal or ventricular infection. Hydrocephalus may require a shunt procedure.