INTRODUCTION: Prenatal diagnosis of myelomeningocele (MMC) has permitted a better planning for optimum management of the disease. More recently, it has allowed for a possible intrauterine repair of the spinal defect. OBJECTIVE: To describe neurosurgical outcome in children with myelomeningocele and follow-up at a referral center in Fetal Medicine. Patients were characterized for the development of a protocol suitable for fetal surgery, and fetuses who were possible candidates for intrauterine surgery were identified. MATERIALS AND METHODS: A retrospective descriptive analysis was performed of 98 cases of fetal myelomeningocele, seen at CAISM-UNICAMP, from January 1994 to December 2002, identifying cases with a possible indication for fetal surgery. RESULTS: Mean gestational age at diagnosis was 29 weeks (17-39); level of lesion was above the sacral region in 92.84%; association with hydrocephalus occurred in 78.57%. During clinical course, 82.5% of patients had neurogenic bladder and 60% had neural and mental deficits. Potential intrauterine repair rate was 11.57%, using criteria from the protocol developed in our service. CONCLUSION: Myelomeningocele is associated with severe and frequent sequelae. In virtually 12% of our cases, fetal surgery could have been offered as a therapeutic option.
INTRODUCTION: Prenatal diagnosis of myelomeningocele (MMC) has permitted a better planning for optimum management of the disease. More recently, it has allowed for a possible intrauterine repair of the spinal defect. OBJECTIVE: To describe neurosurgical outcome in children with myelomeningocele and follow-up at a referral center in Fetal Medicine. Patients were characterized for the development of a protocol suitable for fetal surgery, and fetuses who were possible candidates for intrauterine surgery were identified. MATERIALS AND METHODS: A retrospective descriptive analysis was performed of 98 cases of fetal myelomeningocele, seen at CAISM-UNICAMP, from January 1994 to December 2002, identifying cases with a possible indication for fetal surgery. RESULTS: Mean gestational age at diagnosis was 29 weeks (17-39); level of lesion was above the sacral region in 92.84%; association with hydrocephalus occurred in 78.57%. During clinical course, 82.5% of patients had neurogenic bladder and 60% had neural and mental deficits. Potential intrauterine repair rate was 11.57%, using criteria from the protocol developed in our service. CONCLUSION: Myelomeningocele is associated with severe and frequent sequelae. In virtually 12% of our cases, fetal surgery could have been offered as a therapeutic option.
Authors: W A Hogge; J S Dungan; M P Brooks; S A Dilks; P L Abbitt; S Thiagarajah; J E Ferguson Journal: Am J Obstet Gynecol Date: 1990-09 Impact factor: 8.661
Authors: D A Luthy; T Wardinsky; D B Shurtleff; K A Hollenbach; D E Hickok; D A Nyberg; T J Benedetti Journal: N Engl J Med Date: 1991-03-07 Impact factor: 91.245
Authors: Matthew J Gutman; Tony Goldschlager; Rostam D Fahardieh; David Ying; Chris Xenos; R Andrew Danks Journal: Childs Nerv Syst Date: 2011-04-19 Impact factor: 1.475