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

Pinto, Fernando; Matushita, Hamilton; Furlan, André Luiz Beer; Alho, Eduardo Joaquim Lopes; Goldenberg, Dov Charles; Bunduki, Victor; Krebs, Vera Lúcia Jornada; Teixeira, Manoel Jacobsen

doi:10.1159/000209285

Cited by 24 publications

(28 citation statements)

References 37 publications

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“…Investigation of proposed type of delivery revealed high rates (25%) of vaginal delivery. The study suggested that women undergoing transvaginal delivery may receive irregular prenatal care that would consequently lead to the failure of diagnosing MM in the fetus, which in turn may lead to misguided management based on the type of delivery.Vaginal delivery may increase the risk of rupture and infection of MM during the passage of the fetus from the birth canal; however, indication of cesarean delivery in these pregnant women and its benefits in newborn are still controversial 12,24,25 .…”

Section: Discussionmentioning

confidence: 99%

“…Because of the lack of an obstetric department in our hospital, these children usually arrive at our hospital 24 h after birth. This delays the immediate closure of the lesions, which should in fact be corrected immediately 12 , and hinders the training of a multidisciplinary team involved in intrauterine closure and correction of MM 1 . The same situation is observed in other Brazilian states where many maternity hospitals do not have a unit for pediatric neurosurgery, thus making it necessary to transfer these children to other hospitals 22,26 .…”

Section: Discussionmentioning

confidence: 99%

“…All the children included in this study underwent the same protocol for hydrocephalus in case of MM, as those described in previous reports 9,11,12 . Transcranial ultrasonography (TUS) was chosen as the radiological method for diagnosing hydrocephalus in all neonates, as that described in previous studies 15,16,17 , because of the difficulty in performing CT scan or MRI in these children.…”

Section: Methodsmentioning

confidence: 99%

“…In this group, the proposal for treatment was of closure of MM and VP shunt at the same surgical time. VP shunt was chosen as the method of choice for treating hydrocephalus in these children after considering the benefits and drawbacks of endoscopic third ventriculostomy (ETV) in neonates with MM 12,17,21 .…”

Section: Methodsmentioning

confidence: 99%

“…According to the World Health Organization, among 41 evaluated countries, Brazil ranks fourth in the incidence of spina bifida, at a rate of 1.1:1,000 live births 7,8 . Hydrocephalus is present in most children with MM 7,9 , thus making it essential to establish criteria for indicating ventriculoperitoneal (VP) shunts in these children 9,10,11,12 . Brazil is a large country with socioeconomic imbalance 13 and poor accessibility to radiological methods of diagnosis, such as computed tomography (CT) or magnetic resonance imaging (MRI), for routine examination of neonates with neurological diseases in public health hospitals, which makes it difficult to apply standardized protocols followed in developed countries 9,11,14 .…”

mentioning

confidence: 99%

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Clinical and ultrasonographic criteria for using ventriculoperitoneal shunts in newborns with myelomeningocele

Melo¹,

Pacheco²,

Melo³

et al. 2015

Arq. Neuro-Psiquiatr.

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Objective Hydrocephalus is one of the main complications associated with myelomeningocele (MM). This study aimed to identify clinical and ultrasonographic criteria for using ventriculoperitoneal (VP) shunts in this group of patients.Method A retrospective cohort study, based on established protocol for VP shunt implant in hydrocephalic children with MM. Parameters used to guide the indication of VP shunts included measurement of head circumference (HC), evaluation of fontanels, and measurement of lateral ventricular atrium (LVA) width by transcranial ultrasonography.Results 43 children were included in the analysis, of which 74% had hydrocephalus and required a VP shunt. These children had LVA width ≥ 15 mm, showed increased HC, or had bulging fontanels.Conclusion VP shunt is required in children with increased HC (≥ 2 standard deviation regarding age group), bulging fontanels, or LVA width of ≥ 15 mm after the closure of MM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical and ultrasonographic criteria for using ventriculoperitoneal shunts in newborns with myelomeningocele

Melo¹,

Pacheco²,

Melo³

et al. 2015

Arq. Neuro-Psiquiatr.

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Mortality by mode of delivery among infants with spina bifida in Texas

Benjamin

López

Mitchell

et al. 2019

Birth Defects Research

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Background: It is hypothesized that cesarean delivery may reduce mortality among infants with spina bifida (e.g., by reducing trauma to the open lesion); however, few studies have assessed this relationship. Methods: We used the Texas Birth Defects Registry to identify neonates with spina bifida born between 1999 and 2014. The mode of delivery (main exposure) was abstracted from each subject's birth certificate. The vital status (main outcome) was determined based on the presence or absence of a death certificate. When a death certificate was present, survival time was calculated by subtracting the date of birth from the date of death. We then conducted multivariable Cox proportional hazards regression to estimate the adjusted hazard ratio between cesarean delivery and death prior to 29 days. We adjusted for maternal race/ethnicity, maternal education, gestational age/birthweight, and breech presentation. This analysis was repeated for death prior to 365 days. Results: We analyzed 1,983 nonsyndromic, liveborn neonates with spina bifida, and 68% of these neonates were delivered by cesarean. After adjusting for potential confounders, the adjusted hazard ratio [aHR] for death prior to 29 days was 0.77 (95% confidence interval [CI] 0.49, 1.21) and the aHR for death prior to 365 days was 0.93 (95% CI 0.63, 1.38) comparing infants delivered by cesarean to those delivered vaginally. Conclusions: Despite a lack of strong prior epidemiologic evidence, cesarean rates for neonates with spina bifida were high. Further investigations of the relationship between mode of delivery and infant outcomes, including mortality, complications, and long-term prognosis, are warranted. K E Y W O R D S cesarean section, infant mortality, neural tube defects, proportional hazards models, spina bifida

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Myelomeningocele (open spina bifida) — surgical management

Akalan

2011

Advances and Technical Standards in Neurosurgery

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Myelomeningocele has been recognized since ancient times although written descriptions began not before the 17th century. Among all serious congenital malformations, myelomeningocele is unique that is has a steady and considerable prevalence while being compatible with life. It has a dismal prognosis when left untreated where virtually all die within the first year while aggressive treatment have a profound effect on survival and quality of life. Effective surgical treatment became possible parallel to the treatment of hydrocephalus in the late 1950s. Advent of the shunt systems undoubtedly changed the morbidity and mortality rates due to associated hydrocephalus. Aggressive and effective treatment improved survival rates but also those suffering physical and mental disabilities have increased as well. Ethical and socioeconomic concerns have led to proposal for selective treatment criteria which have raised arguments on medical and ethico-legal rounds. After the swing of the pendulum between early treatment in all affected children and selective treatment of those who fulfilled the criteria for good prognosis, early myelomeningocele repair is practiced widely unless the infant is critically ill.Incidence of myelomeningocele has been decreasing especially in the Western world, partly due to prenatal diagnosis and elective terminations, dietary folate supplementation. Still, it is the most common central nervous system malformation and one of the leading causes of paraplegia, worldwide. Unfortunately, gains in the management of myelomeningocele have been mainly on antenatal diagnosis and prevention while efforts on understanding its cause, mechanisms involved are still tentative. Concerning the surgical management, no revolutionary modification improving outcome has been introduced unlike other fields of neurosurgery.Medical management of a child with myelomeningocele requires a lifelong effort of several disciplines including urology, orthopedics physical and social therapy besides neurosurgery. The initial and probably the most crucial step begin with proper repair of the lesion. The aim of surgery, with its simplest definition should be towards maintaining the medical condition of the newborn. In other words, consequences of an open spinal cord segment with associated malformations have to be avoided with appropriate measures. Comparable to the surgical treatment of any congenital malformation, myelomeningocele repair consist of reversing the failed steps of normal neural tube closure. This requires a thorough understanding of the normal and abnormal embryological sequence of events in formation of the spinal cord. Although the purpose of this chapter is to describe the basic concepts and technique of myelomeningocele repair, contemporary information and progress on epidemiology, and etiology and embryology is presented with discussion of controversial issues regarding the selection process, optimal time for surgery and technical modifications.

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

Cited by 24 publications

References 37 publications

Clinical and ultrasonographic criteria for using ventriculoperitoneal shunts in newborns with myelomeningocele

Clinical and ultrasonographic criteria for using ventriculoperitoneal shunts in newborns with myelomeningocele

Mortality by mode of delivery among infants with spina bifida in Texas

Myelomeningocele (open spina bifida) — surgical management

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