Atypical Myelomeningocele vs. Typical Myelomeningocele
Left picture: In contrast to the first evaluation, not a minimal spinal dysraphism is present, but a myelomenigocele with an atypical clinical presentation. In the picture at the bottom clinical presentation after spontaneous epithelization. Right picture: The diagnosis of a myelomeningocele is easier because all its elements are recognizable: An exposed and protruding medullary plate is recognizable in the center which has stopped in an early developmental stage. Divided vertebral arches with with widely standing apart residuals in the periphery. Between the margins of the periphery with only scant epithelization and the medullary plate, the arachnoid is visible. In minimal spinal dysraphism, indeed, skin appendages and dermal sinuses occur, but parts of the central nervous system such as the spinal cord or arachnoid are never visible. Right picture: However, if the lesion is left to itself, and spontaneous epithelization occurs, the findings of a myelomeningocele in the newborn change as shown in the picture at the bottom of the same patient.
Left picture: Over the sacrum a small, spherical and epithelialized structure is recognizable with an appendage reminding of an intestinal segment. Right picture: A anchovy-like structure is visible in the center of a prominent and dark-red peripheral wall which is divided by a fine dark-red midline in two symmetrical halfes, and lies over the lumbosacral spine.