How is spina bifida treated?

Patient's question:

Spina bifida with hypertrichosis

Doctor's answer:

The general surgical principles are to excise the mass, relieve nerve tension, decompress the spinal canal, and reposition the herniated nerve tissue back into the spinal canal, repair soft tissue defects, and avoid prolonged traction on nerve tissue that could worsen symptoms.
To achieve optimal spinal canal exploration and decompression, the incision should ideally be longitudinal. During surgery, careful manipulation is essential to prevent nerve damage and exacerbation of symptoms. The dissection should proceed around the mass, reaching the bony edge of the vertebral defect, and then the lamina should be removed upward to the normal dura mater. The dura mater is then incised downward for exploration. Non-functional scar tissue and tumors should be carefully excised based on the herniated tissue. If necessary, the thickened and tight filum terminale may be sectioned to ensure complete relaxation of the spinal cord and cauda equina. Finally, the dura mater and all layers of tissue should be tightly sutured. If direct closure of the dural opening is not possible, the posterior fascia should be flipped for repair. The dressing must be snug, and patients should be positioned in prone or lateral lying for 2–3 days after surgery and upon suture removal to prevent urine and feces from wetting and contaminating the incision.
If acute hydrocephalus occurs postoperatively, ventriculoperitoneal shunting should be performed. For patients born with complete bilateral lower limb paralysis and incontinence, or those still suffering from significant hydrocephalus, treatment is mandatory.