Myelomeningocele before birth

Background/Aims: To present a protocol of immediate surgical repair of myelomeningocele (MMC) after birth (‘time zero’) and compare this surgical outcome with the surgery performed after the newborn’s admission to the nursery before the operation. Methods: Data from the medical files of 31 patients with MMC that underwent surgery after birth and after admission at the nursery (group I) were compared with a group of 23 patients with MMC admitted and prospectively followed, who underwent surgery immediately after birth – ‘at time zero’ (group II). Results: The preoperative rupture of the MMC occurred more frequently in group I (67 vs. 39%, p < 0.05). The need for ventriculoperitoneal shunt was 84% in group I and 65% in group II and 4 of them were performed during the same anesthetic time as the immediate MMC repair, with no statistically significant difference. Group I had a higher incidence of small dehiscences when compared to group II (29 vs. 13%, p < 0.05); however, there was no statistically significant difference regarding infections. After 1 year of follow-up, 61% of group I showed neurodevelopmental delay, whereas only 35% of group II showed it. Conclusions: The surgical intervention carried out immediately after the birth showed benefits regarding a lower incidence of preoperative rupture of the MMC, postoperative dehiscences and lower incidence of neurodevelopmental delay 1 year after birth.

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Myelomeningocele Carried Out at ‘Time Zero’ Immediately after Birth

Pinto¹,

Matushita²,

Furlan³

et al. 2009

“…The rat fetus at 48 h of development is approximately equivalent to the human fetus at 24 days of development [3]. Osaka et al [7]have studied aborted myelodysplastic embryos and have concluded that the histology of the spinal cord at the level of dysplasia is relatively well preserved as late as the 55th day of gestation. Lendon’s studies [8]support the idea that the ‘dysplastic’ cord has relatively normal neuronal populations in many patients with myelomeningocele examined at autopsy.…”

Section: Discussionmentioning

confidence: 99%

Late Gestational Intrauterine Myelomeningocele Repair Does Not Improve Lower Extremity Function

Tubbs

Chambers²,

Smyth

et al. 2003

Objective: To determine whether intrauterine myelomeningocele repair performed at between 20 and 28 weeks gestation improves lower extremity function (LEF). Methods: Thirty-seven consecutive patients who had undergone intrauterine repair of their myelomeningocele at Vanderbilt University Medical Center had their lower extremity function and radiographic level (first defective vertebral level) compared to these same parameters in 40 controls who had undergone traditional postgestational repair of their myelomeningocele at the Children’s Hospital in Birmingham, Ala., USA. Results: Of all 77 patients (controls and study group), 13 had a LEF that matched their radiographic level, 27 had a LEF that was rostral to their radiographic level, and 37 had a LEF that was caudal to their radiographic level. Further stratification revealed that for the intrauterine repaired myelomeningoceles, 11% had no difference between LEF and radiographic level, 43% had a LEF that was rostral to their radiographic level, and 46% had a LEF that was caudal to their radiographic level. For those closed in a traditional manner, LEF matched their radiographic level, was rostral to their radiographic level, and was caudal to their radiographic level in 22.5%, 27.5%, and 50% respectively. However, the overall mean differences between institutions produced a p-value of 0.2026 (paired t-test). Conclusions: Although the current timing of intrauterine myelomeningocele repair has been found to lessen the degree of herniation of the rhombencephalon and reduce the incidence of shunt-dependent hydrocephalus, it does not statistically improve LEF. Parents should be advised of these findings prior to surgical intervention so as to focus their expectations.

“…There have been several reports supporting the idea that intrauterine repair of myeloschisis decreases the incidence of Chiari II malformations and shunt-dependent hydrocephalus in infants with spina bifida [12,13,14,15]. In contrast, others have reported complications with the mother or instances of symptomatic epidermoid inclusion cysts in the region of the conus [9,16].…”

Section: Discussionmentioning

confidence: 97%

Myeloschisis Repair in a Premature Neonate with a Birth Weight of 599 g

Oi¹,

Miwa²,

Kobayashi

et al. 2011

This report describes the case of a neonate with myeloschisis weighing 599 g that underwent an operation for spinal cord reconstruction resulting in substantial neuronal functional recovery. At 28 weeks of gestation, oligohydramnios was detected and the female fetus was diagnosed with intrauterine growth retardation. At birth by emergency caesarean section, she showed lumbosacral myeloschisis and complete paralysis of the lower extremities. Surgical repair and spinal cord reconstruction was performed 2 days after birth by closing the neural placode. Total blood loss was only 2 ml. Within 3 months of the operation, lower extremity neurologic function gradually improved down to the level of the knee joint. To our knowledge, this case is the lowest recorded body weight for a neonate with myeloschisis repair at birth, and this further suggests the possibility of improvement of lower extremity neurologic function after birth and surgical reconstruction.