The pediatric neurosurgery team at UF Health Shands Children’s Hospital in Gainesville, Florida, offers children the latest and most advanced options for treating spina bifida. Our spina bifida surgery program is committed to providing state-of-the-art care to improve the quality of life of our patients. We strive to alleviate worry and suffering and provide outstanding care for children of all ages.
We treat all types of spina bifida, including:
- Myelomeningocele — the most common and most severe form
- Spina bifida occulta
- Tethered spinal cord
- Filum terminale lipoma
- Dermal sinus tract
Signs and Symptoms
The most common sign of spina bifida is an abnormality along the spine that is noted at birth. The abnormality may be an open defect (myelomeningocele), fatty mass, dimple, hemangioma, hairy patch, asymmetric gluteal fold and/or imperforate anus. Children born with myelomeningocele will usually also have a Chiari malformation type II and hydrocephalus.
Symptoms of a tethered spinal cord may include bladder or bowel difficulties, weakness, numbness/tingling, walking on the tips of the toes from tight hamstrings, scoliosis (spinal curvature), foot deformities and/or spinal deformities. Pain in the back and/or legs may or may not be related.
Most infants with spina bifida will need surgery to correct the defect. During the operation to repair open defects, the spinal cord and its nerve roots are put into their proper place and covered with skin. The goal of closed defect repair is to separate the spinal cord from atypical attachments which may cause abnormal tension over time.
Sometimes, additional surgeries may be required to correct spinal, foot or leg deformities. Surgery for a Chiari malformation type II is possible but not likely. More commonly, spina bifida patients with hydrocephalus require surgical treatment. While the traditional treatment for hydrocephalus is placement of a ventricular shunt, some patients are candidates for minimally invasive endoscopic treatment without a shunt.
This minimally invasive technique combines endoscopic third ventriculostomy, or ETV, with choroid plexus cauterization, or CPC. The procedure is called ETV-CPC.
More about ETV-CPC
UF Health Shands Children’s Hospital is the only hospital in Florida and among only a handful of children’s hospitals in the nation that offers ETV-CPC using the method pioneered by Benjamin Warf, MD, at Boston Children’s Hospital.
During the ETV-CPC procedure, one of our neurosurgeons will create an opening in the third ventricular floor to allow cerebrospinal fluid, or CSF, to pass from the inside to the outside of the brain. After this ETV component, Dr. Governale or Dr. Blatt will then endoscopically cauterize much of the choroid plexus, the tissue that produces CSF. The combination of ETV and CPC reduces CSF production and bypasses the flow blockage(s).
In eligible patients, ETV-CPC can have a 50 to 70 percent success rate in preventing the need for shunt placement. If the ETV-CPC procedure treats the hydrocephalus successfully for six months, it is likely to treat it in the long term. If the hydrocephalus returns, the child may need a shunt placed.
The dedicated spina bifida team at UF Health Shands Children’s Hospital is here to help and answer any questions a family may have about the best treatment plan for their child. Pediatric specialists from neurosurgery, urology, orthopedic surgery, plastic surgery, gastroenterology, physical/occupational therapy, neuropsychology and social work all work together to optimize the care of every child with spina bifida.
At UF Health Shands Children’s Hospital, every child diagnosed with a condition requiring neurosurgical expertise is cared for with an individualized treatment plan. We see patients within just a few days for non-emergency cases and within 24 hours for urgent cases.
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