Myelomeningocele: Prenatal Evaluation—Comparison between Transabdominal US and MR Imaging

Aaronson, Oran S.; Hernanz‐Schulman, Marta; Bruner, Joseph P.; Reed, George W.; Tulipan, Noel

doi:10.1148/radiol.2273020535

Cited by 84 publications

(52 citation statements)

References 18 publications

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“…Patient stratification, however, remains challenging and can present as significant ethical dilemmas, especially in light of the fact that prenatal repair and termination of pregnancy are among the options to be considered [1]. At this time, prenatal staging of NTDs is done primarily by imaging, which can provide both anatomical and functional information, yet it has been of limited prognostic value [1,2,3,4,5,6,7,8,9]. …”

Section: Introductionmentioning

confidence: 99%

The Impact of Gestational Age on Targeted Amniotic Cell Profiling in Experimental Neural Tube Defects

Pennington

Rialon²,

Dionigi³

et al. 2014

Fetal Diagn Ther

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Purpose: The proportions of select stem cells in term amniotic fluid have been shown to correlate with the type and size of experimental neural tube defects (NTDs). We sought to determine the impact of gestational age upon this form of targeted amniotic cell profiling. Methods: Sprague-Dawley fetuses with retinoic acid-induced NTDs (n = 110) underwent amniotic fluid procurement at four time points in gestation. Samples were analyzed by flow cytometry for the presence of cells concomitantly expressing Nestin and Sox-2 (neural stem cells, aNSCs) and cells concomitantly expressing CD29 and CD44 (mesenchymal stem cells, aMSCs). Statistical analysis was by nonparametric Kruskal-Wallis ANOVA (p < 0.05). Results: There was a statistically significant impact of gestational age on the proportions of both aMSCs (p = 0.01) and aNSCs (p < 0.01) in fetuses with isolated spina bifida. No such impact was noted in normal fetuses (p > 0.10 for both cells), in isolated exencephaly (p > 0.10 for both cells), or in combination defects (p > 0.10 for both cells). Gestational age had no effect on aNSC/aMSC ratios. Conclusions: Targeted quantitative amniotic cell profiling varies with gestational age in experimental isolated spina bifida. This finding should be considered prior to the eventual translation of this diagnostic adjunct into the prenatal evaluation of these anomalies.

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Section: Introductionmentioning

confidence: 99%

The Impact of Gestational Age on Targeted Amniotic Cell Profiling in Experimental Neural Tube Defects

Pennington

Rialon²,

Dionigi³

et al. 2014

Fetal Diagn Ther

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“…Otherwise, the intrauterine MMC surgical repair substantially reduced the incidence of shunt-dependent hydrocephalus with most of this benefit for the MMC lesions located below L3 [25,26,27,28]. The fetal surgery results on the MMC are preliminary and probably due to several limiting factors including the timing of surgery, selection of the cases and technical difficulties [28, 29]. Our study suggests that other factors that have often been undervalued, such as vertical spinal cord stretching or even chemical aggression, may explain the upstream astrocytosis that goes well beyond the MMC limits and can be a further explanation for the suboptimal results of the in utero surgical repair.…”

Section: Discussionmentioning

confidence: 99%

Immunocytochemical Characterization of Astrocytosis along the Spinal Cord of Loop-Tail/Curly-Tail Mice with Myelomeningocele

Reis

Correia‐Pinto²,

Monteiro³

et al. 2008

Pediatr Neurosurg

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Background: The neurological deficits of myelomeningocele (MMC) have been attributed both to a primary neurulation defect and to a secondary injury of the placode in the intrauterine environment. Since astrocytes are involved in glial scar formation after spinal cord injury, the characterization of astrocyte density along the spinal cord upstream of the MMC can be used as a surrogate marker of the extension of the injury beyond the MMC. Methods: The curly-tail/loop-tail murine model was applied to obtain newborn mice with MMC. The astrocyte density and topography both at the MMC placode level and at the upper segments of the spinal cord was characterized by immunolabeling using the anti-glial fibrillary acidic protein antibody. This was followed by a qualitative evaluation of immunolabeled cells and morphometric analysis of the samples. Results: The topography of astrocytes in the spinal cord of MMC newborn mice was compared with that of newborn control mice (without spina bifida aperta) (n = 8/group). The anti-glial fibrillary acidic protein immunoreactivity was significantly increased in the MMC samples in comparison with the normal spinal cord, indicating the presence of an astrocytic response. Increased astrocytosis was also observed in the transitional area located above the MMC. The astrocytosis decreased progressively along the MMC spinal cord until matching the pattern of the control spinal cords. This transitional area involved a segment of the spinal cord with a length of 240 µm in the newborn mouse. Conclusions: MMC newborn mice show spinal cord injury that is located upstream of the exposed placode and is characterized by proliferation of astrocytes. This finding offers further support for the hypothesis of a tethering mechanism as part of the spinal cord injury observed in MMC newborns.

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“…[3][4][5] If results are not diagnostic, magnetic resonance imaging (MRI) is often used. 6 Although obviously an emotional diagnosis, it affords the family an opportunity to prepare themselves for the challenges ahead. Although controversial, in-utero closure of the open neural tube defect may offer some advantages to the child, but the risks of preterm labor (13% delivered at less than 30 weeks gestation) and maternal health remain significant concerns.…”

Section: Prenatalmentioning

confidence: 99%

“…If even the best operation is performed in the wrong patient, the results can be disastrous. 6,26,27 It has been shown that the most important factor in successful outcomes is proper family selection. [7][8][9]28 Bladder neck procedures range from endoscopic injections of the bladder neck to outpatient suburethral slings, to bladder neck reconstruction, to ligation or closure of the bladder neck.…”

Section: Elementary Schoolmentioning

confidence: 99%

Neuropathic bladders: Investigation and treatment through their lifetime

Metcalfe¹

2017

CUAJ

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The child with a neuropathic bladder requires lifelong dedicated care. Just as each patient presents with unique physiology, each phase of their life presents varying challenges. The primary concern for our patients is their renal health, but continence and independence also play significant roles. Most patients can be managed conservatively, but a myriad of surgical options are also available, reinforcing our emphasis on individualized care. Appropriate presurgical planning is required to ensure the right patient receives the best operation for his/her wants and needs. Furthermore, the numerous potential complications must be understood and longterm followup and surveillance is required.This review outlines the basic pathophysiology, investigations, and treatments, with a focus on the changing needs throughout their lives.

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Myelomeningocele: Prenatal Evaluation—Comparison between Transabdominal US and MR Imaging

Cited by 84 publications

References 18 publications

The Impact of Gestational Age on Targeted Amniotic Cell Profiling in Experimental Neural Tube Defects

The Impact of Gestational Age on Targeted Amniotic Cell Profiling in Experimental Neural Tube Defects

Immunocytochemical Characterization of Astrocytosis along the Spinal Cord of Loop-Tail/Curly-Tail Mice with Myelomeningocele

Neuropathic bladders: Investigation and treatment through their lifetime

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