Improvement of motor function and decreased need for postnatal shunting in children who had undergone intrauterine myelomeningocele repair

Faria, Tereza Cristina Carbonari de; Cavalheiro, Sérgio; Hisaba, W. J.; Moron, Antônio Fernandes; Torloni, Maria Regina; Oliveira, Ana Lúcia Batista de; Borges, Carolina

doi:10.1590/0004-282x20130104

Cited by 20 publications

(19 citation statements)

References 22 publications

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“…1 Smaller clinical studies in other centers have had similar results. [19][20][21] Our findings are in keeping with these studies because we found that 81% of fetuses that underwent prenatal repair had resolved cerebellar ectopia postnatally, a result that was not observed in any of the fetuses that underwent postnatal repair. Our study adds to the clinical literature by describing in more detail the imaging findings on both pre-and postnatal MR imaging by adapting the grading system used by Sutton et al 2 on fetal MR imaging, which can be applied to clinical practice.…”

Section: Discussionsupporting

confidence: 86%

Hindbrain Herniation in Chiari II Malformation on Fetal and Postnatal MRI

Nagaraj

Bierbrauer

Zhang

et al. 2017

AJNR Am J Neuroradiol

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Section: Discussionsupporting

confidence: 86%

Hindbrain Herniation in Chiari II Malformation on Fetal and Postnatal MRI

Nagaraj

Bierbrauer

Zhang

et al. 2017

AJNR Am J Neuroradiol

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“…Finally, we reviewed all retrospective cohort studies and case series reporting on neurodevelopmental outcome of infants after prenatal repair of SBA (Table S1). These could not be included in the qualitative and quantitative analysis since they did not match the inclusion criteria regarding the study design, and only one of these reported on a postnatal‐repair cohort as a control group. After including this study in the meta‐analysis, the conclusions regarding the primary outcome measure and selected secondary outcome measures (shunt placement rate, independent ambulation) did not change (Figure S1).…”

Section: Resultsmentioning

confidence: 99%

“…Appendix S1 Search strategy Figure S1 Meta-analysis for presence of neurodevelopmental impairment (a), need for ventriculoperitoneal shunt placement by 12 months postpartum (b) and independent ambulation at 30 months (c), in infants that had prenatal vs those that had postnatal surgical repair of spina bifida aperta, including findings of study by Faria et al 25 .…”

Section: Supporting Information On the Internetmentioning

confidence: 99%

Neurodevelopmental outcome of children with spina bifida aperta repaired prenatally vs postnatally: systematic review and meta‐analysis

Inversetti

Veeken

Thompson

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To assess the neurodevelopmental outcome of children with spina bifida aperta (SBA) treated prenatally as compared to those treated postnatally. Methods We performed a systematic review of the literature in PubMed/MEDLINE, EMBASE, Web of Science and The Cochrane Library, comparing the neurological outcome of infants with SBA treated prenatally vs postnatally. Only randomized controlled trials (RCTs) and non‐randomized prospective controlled studies were included. The primary outcome assessed was neurodevelopmental impairment at the age of 1 year or later. Secondary outcomes were preterm birth, need for ventriculoperitoneal (VP) shunt by 12 months of age, absence of signs of hindbrain herniation at the first postnatal magnetic resonance imaging (MRI) evaluation and independent ambulation evaluated at 30 months. Results Of 11 359 studies identified through the electronic search, six met the inclusion criteria and were assessed in full text and two, one RCT and one prospective cohort study, were ultimately included in the meta‐analysis. Sensitivity analysis did not show any difference between the outcomes of the RCT alone and those of the pooled RCT and prospective cohort study. This allowed neurodevelopmental assessment of 213 children between 14 and 53 months of age. Neurodevelopment was assessed by the Bayley Scales of Infant Development II (BSID‐II) mental development index corrected for chronological age, with a cut‐off of ≥ 70 (representing no more than 2 SD below the mean). The presence of neurodevelopmental impairment was similar between children who underwent prenatal (25/105 (23.8%)) and those who had postnatal (30/108 (27.8%)) repair of SBA (odds ratio (OR), 0.82 (95% CI, 0.43–1.56); P = 0.54), although the risk of prematurity was higher in the prenatal‐repair group (OR, 17.62 (95% CI, 7.60–40.87); P < 0.0001). For every two fetuses operated on before birth, there was, compared with those operated on after birth, one additional premature birth (number needed to harm = 2 (95% CI, 1–3)). The need for VP shunt placement by 12 months of age was lower in the prenatal‐repair group (45/109 (41.3%)) than in children that had postnatal repair (93/112 (83.0%); OR, 0.14 (95% CI, 0.08–0.26); P < 0.0001). Data on neurodevelopmental impairment in children with a shunt were available only for patients from the prenatal‐surgery group of the RCT; in this subgroup, the likelihood for impairment was similar between children who did (7/39 (17.9%)) and those who did not (4/48 (8.3%)) have shunt placement (P = 0.21). At first postnatal MRI evaluation, no signs of hindbrain herniation were detected in 28/88 (31.8%) children who were operated on prenatally compared with 4/89 (4.5%) who had postnatal repair (OR, 9.45 (95% CI, 3.12–28.64); P < 0.0001). Independent ambulation at 30 months was achieved by 41/109 (37.6%) children who underwent prenatal repair compared with 21/111 (18.9%) who had postnatal repair (OR, 2.59 (95% CI, 1.39–4.86); P = 0.003). Conclusion The risk of neurodevelopmental impairment in infan...

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“…This closure disorder occurs in the third week of gestation, and biochemical, genetic, and environmental phenomena are involved in its genesis. Ninety percent of myelomeningocele patients develop hydrocephalus due to Chiari malformation type II and require ventricular shunts after birth [26]. Therefore, the main goal of the fetal surgery for myelomeningocele before 27 weeks of gestation is to reduce the ventricular shunt rates and revert the Chiari type II.…”

Section: Myelomeningocelementioning

confidence: 99%

Antenatal management of fetal neurosurgical diseases

et al. 2017

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The advance in the imaging tools during the pregnancy (ultrasound and magnetic resonance) allowed the early diagnose of many fetal diseases, including the neurological conditions. This progress brought the neurosurgeons the possibility to propose treatments even before birth. Myelomeningocele is the most recognized disease that can be treated during pregnancy with a high rate of success. Additionally, this field can be extended to other conditions such as hydrocephalus and encephaloceles. However, each one of these diseases has nuances in the diagnostic evaluation that should fit the requirements to perform the fetal procedure and overbalance the benefits to the patients. In this article, the authors aim to review the neurosurgical aspects of the antenatal management of neurosurgical conditions based on the experience of a pediatric neurosurgery center.

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Improvement of motor function and decreased need for postnatal shunting in children who had undergone intrauterine myelomeningocele repair

Cited by 20 publications

References 22 publications

Hindbrain Herniation in Chiari II Malformation on Fetal and Postnatal MRI

Hindbrain Herniation in Chiari II Malformation on Fetal and Postnatal MRI

Neurodevelopmental outcome of children with spina bifida aperta repaired prenatally vs postnatally: systematic review and meta‐analysis

Antenatal management of fetal neurosurgical diseases

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