Improvement in hindbrain herniation demonstrated by serial fetal magnetic resonance imaging following fetal surgery for myelomeningocele.
Leslie N. Sutton,N S Adzick,Larissa T. Bilaniuk,Mark P. Johnson,Timothy M. Crombleholme,Alan W. Flake +5 more
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TLDR
In this series of patients, fetal myelomeningocele closure resulted in improvement in hindbrain herniation as demonstrated by serial MRI scans.Abstract:
ContextHindbrain herniation occurs in a large percentage of children with myelomeningocele
and is the leading cause of death in this population. The effect of early
fetal closure of myelomeningocele on hindbrain herniation is unknown.ObjectiveTo determine whether early fetal closure of myelomeningocele affects
hindbrain herniation.DesignCase series of patients undergoing fetal myelomeningocele closure with
serial measurements of hindbrain herniation and a mean follow-up of 182 days.SettingTertiary care medical center.ParticipantsTen patients undergoing fetal myelomeningocele closure at 22 to 25 weeks'
gestation between March 1998 and February 1999.Main Outcome MeasuresNeed for shunt placement; degree of hindbrain herniation (grades 0-3)
found on magnetic resonance imaging (MRI) performed prior to surgery and 3
and 6 weeks after fetal surgery, as well as shortly after birth; gestational
age at delivery.ResultsAll initial fetal MRI scans performed at 19 to 24 weeks' gestation showed
significant (grade 3) cerebellar herniation and absence of spinal fluid spaces
around the cerebellum. Six fetuses were delivered electively at 36 weeks'
gestation after lung maturity was established. The other 4 were delivered
prematurely, at 25, 30, 30, and 31 weeks of gestation, and the 25-week gestation
neonate died. All 9 surviving neonates showed improvement in the hindbrain
hernia at the 3-week postoperative fetal scan (grade 2, n = 4; grade 1, n
= 5). On the postnatal scan, all patients showed grade 1 hindbrain herniation.
Only 1 patient required placement of a ventriculoperitoneal shunt.ConclusionIn this series of patients, fetal myelomeningocele closure resulted
in improvement in hindbrain herniation as demonstrated by serial MRI scans.read more
Citations
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Journal ArticleDOI
A Randomized Trial of Prenatal versus Postnatal Repair of Myelomeningocele
N. Scott Adzick,Elizabeth Thom,Catherine Y. Spong,John W. Brock,Pamela K. Burrows,Mark P. Johnson,Lori J. Howell,Jody A. Farrell,Mary E. Dabrowiak,Leslie N. Sutton,Nalin Gupta,Noel Tulipan,Diana L. Farmer +12 more
TL;DR: Prenatal surgery for myelomeningocele reduced the need for shunting and improved motor outcomes at 30 months but was associated with maternal and fetal risks and increased risk of preterm delivery and uterine dehiscence at delivery.
Journal ArticleDOI
A Randomized Trial of Prenatal Versus Postnatal Repair of Myelomeningocele
N. Scott Adzick,Elizabeth Thom,Catherine Y. Spong,John W. Brock,Pamela K. Burrows,Mark P. Johnson,Lori J. Howell,Jody A. Farrell,Mary E. Dabrowiak,Leslie N. Sutton,Nalin Gupta,Noel Tulipan,Mary E. D'Alton,Diana L. Farmer +13 more
TL;DR: Myelomeningocele is one of the most common birth defects, characterized by a defect in the bony spine and resultant extrusion of the spinal cord into a sac filled with cerebrospinal fluid.
Journal ArticleDOI
A new look at myelomeningoceles: functional level, vertebral level, shunting, and the implications for fetal intervention.
Natalie E. Rintoul,Leslie N. Sutton,Anne M. Hubbard,Brian Cohen,Jeanne Melchionni,Patrick S. Pasquariello,N. Scott Adzick +6 more
TL;DR: The natural history of ventricular shunting in MMC patients with relation to both radiologic and functional criteria is described andfetal MMC closure is being performed in some centers in an attempt to decrease the incidence of shunting and to improve leg function in selected patients.
Journal ArticleDOI
Fetal myelomeningocele: natural history, pathophysiology, and in-utero intervention
TL;DR: Preliminary results suggest that fetal surgery results in reversal of hindbrain herniation, a decrease in shunt-dependent hydrocephalus, and possibly improvement in leg function, but these findings might be explained by selection bias and changing management indications.
References
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Journal ArticleDOI
In utero surgery rescues neurological function at birth in sheep with spina bifida.
Martin Meuli,Claudia Meuli-Simmen,Grover M. Hutchins,Charles D. Yingling,Hoffman Km,Michael R. Harrison,N S Adzick +6 more
TL;DR: It is reported here that exposure of the normal spinal cord to the amniotic cavity in midgestational sheep fetuses leads to a human-like open spina bifida with paraplegia at birth, indicating that the exposed neural tissue is progressively destroyed during pregnancy.
Journal ArticleDOI
The Paralysis Associated with Myelomeningocele: Clinical and Experimental Data Implicating a Preventable Spinal Cord Injury
TL;DR: A "two-hit" hypothesis to explain the paralysis seen in children with myelomeningocele: congenital myelodysplasia complicated by an intrauterine spinal cord injury andIntrauterine protection of the exposed spinal cord might prevent some or all of the paralysis.
Journal ArticleDOI
Successful fetal surgery for spina bifida
Journal ArticleDOI
Endoscopic coverage of fetal myelomeningocele in utero
TL;DR: Minimally invasive fetal surgery appears to constitute a feasible approach to nonlethal fetal malformations that result in progressive and disabling organ damage.
Journal Article
Prevalence of spina bifida at birth--United States, 1983-1990: a comparison of two surveillance systems.
Joseph M. Lary,Larry D. Edmonds +1 more
TL;DR: In this paper, a collaborative effort by CDC and state birth defect surveillance programs in 16 states to obtain multistate, population-based data concerning the birth prevalence and descriptive epidemiology of spina bifida and determine the usefulness of combining state surveillance data to monitor national trends in the birth prevalences of NTDs.