Michael J Cools1,2, Alan R Tang3,4, Sumit Pruthi5, Tae Ho Koh6, Stephane A Braun7,8, Kelly A Bennett8,9, John C Wellons10,3,8. 1. Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, Suite T-4224, Nashville, TN, USA. michaeljcools@gmail.com. 2. Surgical Outcomes Center for Kids (SOCKs), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA. michaeljcools@gmail.com. 3. Surgical Outcomes Center for Kids (SOCKs), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA. 4. Vanderbilt University School of Medicine, Nashville, TN, USA. 5. Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA. 6. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA. 7. Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 8. The Fetal Center at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA. 9. Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA. 10. Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, Suite T-4224, Nashville, TN, USA.
Abstract
INTRODUCTION: Intrauterine myelomeningocele repair (IUMR) and postnatal myelomeningocele repair (PNMR) differ in terms of both setting and surgical technique. A simplified technique in IUMR, in which a dural onlay is used followed by skin closure, has been adopted at our institution. The goal of this study was to compare the rates of clinical tethering in IUMR and PNMR patients, as well as to evaluate the appearance on MRI. METHODS: We conducted a retrospective review of 36 patients with MMC repaired at our institution, with 2:1 PNMR to IUMR matching based on lesion level. A pediatric neuroradiologist blinded to the clinical details reviewed the patients' lumbar spine MRIs for the distance from neural tissue to skin and the presence or absence of a syrinx. An EMR review was then done to evaluate for detethering procedures and need for CSF diversion. RESULTS: Mean age at MRI was 4.0 years and mean age at last follow-up was 6.1 years, with no significant difference between the PNMR and IUMR groups. There was no significant difference between groups in the distance from neural tissue to skin (PNMR 13.5 mm vs IUMR 17.6 mm; p = 0.5). There was no difference in need for detethering operations between groups (PNMR 12.5% vs IUMR 16.7%; RR 0.75; CI 0.1-5.1). CONCLUSIONS: There was no significant difference between postnatal- and intrauterine-repaired myelomeningocele on MRI or in need for detethering operations. These results imply that a more straightforward and time-efficient IUMR closure technique does not lead to an increased rate of tethering when compared to the multilayered PNMR.
INTRODUCTION: Intrauterine myelomeningocele repair (IUMR) and postnatal myelomeningocele repair (PNMR) differ in terms of both setting and surgical technique. A simplified technique in IUMR, in which a dural onlay is used followed by skin closure, has been adopted at our institution. The goal of this study was to compare the rates of clinical tethering in IUMR and PNMR patients, as well as to evaluate the appearance on MRI. METHODS: We conducted a retrospective review of 36 patients with MMC repaired at our institution, with 2:1 PNMR to IUMR matching based on lesion level. A pediatric neuroradiologist blinded to the clinical details reviewed the patients' lumbar spine MRIs for the distance from neural tissue to skin and the presence or absence of a syrinx. An EMR review was then done to evaluate for detethering procedures and need for CSF diversion. RESULTS: Mean age at MRI was 4.0 years and mean age at last follow-up was 6.1 years, with no significant difference between the PNMR and IUMR groups. There was no significant difference between groups in the distance from neural tissue to skin (PNMR 13.5 mm vs IUMR 17.6 mm; p = 0.5). There was no difference in need for detethering operations between groups (PNMR 12.5% vs IUMR 16.7%; RR 0.75; CI 0.1-5.1). CONCLUSIONS: There was no significant difference between postnatal- and intrauterine-repaired myelomeningocele on MRI or in need for detethering operations. These results imply that a more straightforward and time-efficient IUMR closure technique does not lead to an increased rate of tethering when compared to the multilayered PNMR.
Authors: Jochem K H Spoor; Pravesh S Gadjradj; Alex J Eggink; Philip L J DeKoninck; Bart Lutters; Jeroen R Scheepe; Jetty van Meeteren; Peter C J de Laat; Marie Lise van Veelen; Tjeerd H R de Jong Journal: Neurosurg Focus Date: 2019-10-01 Impact factor: 4.047
Authors: Julie S Moldenhauer; Shelly Soni; Natalie E Rintoul; Susan S Spinner; Nahla Khalek; Juan Martinez-Poyer; Alan W Flake; Holly L Hedrick; William H Peranteau; Norma Rendon; Jamie Koh; Lori J Howell; Gregory G Heuer; Leslie N Sutton; Mark P Johnson; N Scott Adzick Journal: Fetal Diagn Ther Date: 2014-08-15 Impact factor: 2.587
Authors: N Scott Adzick; Elizabeth A 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 B Tulipan; Mary E D'Alton; Diana L Farmer Journal: N Engl J Med Date: 2011-02-09 Impact factor: 91.245
Authors: Noel Tulipan; John C Wellons; Elizabeth A Thom; Nalin Gupta; Leslie N Sutton; Pamela K Burrows; Diana Farmer; William Walsh; Mark P Johnson; Larry Rand; Susan Tolivaisa; Mary E D'alton; N Scott Adzick Journal: J Neurosurg Pediatr Date: 2015-09-15 Impact factor: 2.375