Yes, spina bifida affects the brain in several significant ways. Although it begins as a defect in the spine, the condition alters brain development before birth and can shape cognitive function throughout life. About 80% of people with the most common severe form (myelomeningocele) develop excess fluid in the brain, and nearly all show structural differences in brain anatomy that influence learning, memory, and attention.
How a Spinal Defect Changes the Brain
The connection between spine and brain starts early in fetal development. When the neural tube fails to close properly, cerebrospinal fluid leaks out through the opening in the spine. This fluid loss changes the pressure environment inside the developing skull, causing the brain structures to become overcrowded in a smaller-than-normal space. The result is a cascade of changes: the base of the brain gets pulled downward toward the spinal canal, the fluid-filled chambers inside the brain shrink or become misshapen, and the fetal skull itself develops differently.
This downward displacement of the brain is called a Chiari II malformation, and it occurs in the vast majority of children born with myelomeningocele. The lower part of the brain, which controls breathing, swallowing, and balance, gets compressed as it’s pushed into the top of the spinal canal. In most cases the compression is mild enough that it doesn’t cause obvious symptoms, but some children develop breathing difficulties, feeding problems, or trouble with coordination that require surgical intervention to relieve pressure at the base of the skull.
Hydrocephalus and Fluid Buildup
The most common brain complication of spina bifida is hydrocephalus, a buildup of cerebrospinal fluid that puts pressure on the brain. Data from the National Spina Bifida Patient Registry, which tracked over 4,400 patients across 26 institutions, found that 80% of people with myelomeningocele had undergone at least one surgery to manage hydrocephalus. Rates ranged from 72% to 96% depending on the treatment center.
Most of these surgeries involve placing a shunt, a thin tube that drains excess fluid from the brain into the abdomen where the body can absorb it. Shunts are effective but not permanent. They can become blocked, infected, or outgrown, often requiring revision surgeries over a person’s lifetime. Fetal surgery, where the spinal opening is repaired before birth, has shown promise in reducing the need for shunts. In one study, 59% of babies who had prenatal repair needed a shunt compared to 91% of those who had traditional postnatal surgery.
When hydrocephalus is well controlled, the brain can develop and function much closer to its potential. When it isn’t caught or treated effectively, the sustained pressure can damage brain tissue and worsen cognitive and motor outcomes.
Structural Differences in the Brain
Beyond fluid buildup, the brains of people with spina bifida show consistent structural differences. One of the most striking involves the corpus callosum, the thick band of nerve fibers that connects the left and right halves of the brain and allows them to communicate. In a study of children with myelomeningocele, only 4.1% had a fully normal corpus callosum. The rest showed partial underdevelopment, most commonly in the front and back portions of the structure. Complete absence didn’t occur, but the degree of thinning and missing sections varied widely.
The brain appears to partially compensate for these missing connections. In about 13% of cases, a nearby pathway called the hippocampal commissure was enlarged, potentially picking up some of the communication workload. Other potential backup pathways were far less common, appearing in only about 3% of cases.
Thinning of brain tissue also occurs in the back portions of the brain, particularly in the parietal and occipital regions. These areas handle spatial reasoning, number processing, and visual information. This thinning helps explain some of the specific learning patterns seen in spina bifida.
Cognitive Patterns and Learning
Spina bifida creates a recognizable cognitive profile. People with the condition typically have stronger verbal skills than visual-spatial skills, and they tend to struggle most with math, attention shifting, and memory. Intelligence varies widely, and many individuals have IQ scores in the normal range, but specific cognitive challenges are common even when overall intelligence is average.
Math difficulties are particularly well documented and have a clear neurological basis. The parietal lobe, which thins in many people with spina bifida, contains circuits essential for processing quantities, estimating, and understanding numbers spatially. Changes in the midbrain can also affect visual exploration and fine motor skills like pointing, which are building blocks for mathematical thinking in early childhood. These challenges tend to emerge in preschool and persist through school age.
Executive function, the set of mental skills that help with planning, organizing, and self-monitoring, is another area of difficulty. Metacognition, which is the ability to evaluate your own thinking and adjust your approach when something isn’t working, poses particular challenges. This can make independent problem-solving harder in school and daily life.
Attention shows an interesting split. Children with spina bifida often have trouble shifting their focus from one thing to another and are easily distracted. However, sustained attention, the ability to stay focused on a single task over time, tends to be well preserved. This means a child might struggle to transition between activities but perform well once they’re locked into a task.
Memory difficulties appear early and persist across the lifespan, affecting both what people hear and what they see. These aren’t catastrophic memory failures but consistent weaknesses that can make learning new material slower and less reliable without extra support.
Seizure Risk
People with spina bifida face a higher-than-average risk of seizures, though the risk depends heavily on whether they have a shunt. Children with myelomeningocele who don’t have shunts have a seizure rate of roughly 2% to 8%, not dramatically higher than the general population. Those with shunts face higher rates, with one study finding seizures in 21% of children and epilepsy (recurrent seizures) in about 17%. Shunt complications, particularly infections or malfunctions that cause sudden pressure changes in the brain, are a common trigger.
Tethered Cord and Ongoing Monitoring
Even after initial surgical repair, the spinal cord can become stuck or “tethered” to surrounding tissue as scar tissue forms. A tethered cord pulls on the lower spinal cord as a child grows, and while its primary effects are in the legs and bladder, it can also contribute to the development of fluid-filled cysts within the spinal cord. In rare cases, tethered cord goes undiagnosed in childhood and only causes symptoms in adulthood. Regular monitoring throughout life helps catch these complications before they cause permanent damage.
The Chiari II malformation itself can also shift over time. Current surgical guidelines recommend intervention when symptoms appear or when imaging shows the condition is progressing even without symptoms. In children, surgery typically involves removing a small amount of bone to give the brain more room. Adults may need a more involved procedure, but both approaches aim to relieve compression before it causes lasting harm.
What This Means Day to Day
The brain effects of spina bifida are lifelong but manageable with the right support. Early intervention programs that target math readiness, memory strategies, and attention skills can make a meaningful difference in school performance. Neuropsychological testing helps identify each person’s specific pattern of strengths and weaknesses, which guides the kind of academic accommodations and therapies that will actually help rather than offering generic support.
Many people with spina bifida attend mainstream schools, hold jobs, and live independently. The cognitive profile associated with the condition is consistent enough that educators and clinicians who specialize in spina bifida can anticipate challenges and put supports in place early. Understanding that the brain is involved, not just the spine, is the first step toward getting the right kind of help.