The spinal cord lesion in human fetuses with myelomeningocele: Implications for fetal surgery

Meuli, Martin; Meuli‐Simmen, Claudia; Hutchins, Grover M.; Seller, Mary J.; Harrison, Michael R.; Adzick, N. Scott

doi:10.1016/s0022-3468(97)90603-5

Cited by 203 publications

(145 citation statements)

References 8 publications

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“…First, the AM may serve as a protective physical barrier. The importance of spinal cord protection in MMC repair is based on evidence that the disease results from both abnormal neural tube development and subsequent spinal cord damage during gestation and delivery, the latter of which can be ameliorated with increased protection in utero [13,15]. The increased preservation of spinal cord tissue in AM-repaired lambs compared to skin only-repaired and unrepaired lambs may simply represent the benefit of increased protection from further intrauterine trauma secondary to use of a thicker patch for repair.…”

Section: Discussionmentioning

confidence: 99%

“…The first operation was performed at approximately 75 days of gestation, at which time each ewe underwent survival laparotomy and hysterotomy followed by creation of the MMC defect. As described previously, the MMC defect was surgically created by exposing the spinal cord and removing the dura of each fetal lamb [12,13]. A second survival laparotomy and hysterotomy were performed at approximately 100 days gestation.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

In utero repair of myelomeningocele with autologous amniotic membrane in the fetal lamb model

Brown

Saadai

Pivetti

et al. 2014

Journal of Pediatric Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

In utero repair of myelomeningocele with autologous amniotic membrane in the fetal lamb model

Brown

Saadai

Pivetti

et al. 2014

Journal of Pediatric Surgery

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“…In Brazil, the prevalence of neural tube defects ranges from 1.3 cases per 1,000 infants born in São José dos Campos (SP) (3) , to 5 cases per 1,000 infants born in Recife (PE) (4) . Experimental studies suggest that the spinal cord is progressively damaged during intrauterine life due to the exposure of the normal nervous tissue to mechanic (fetal movement) and chemical (amniotic liquid) aggressions resulting from the lack of closure of posterior structures (5) . The recent publication of the results of the randomized clinical trial "Management of Myelomeningocele Study" (MOMS), performed in the United States, showed that intra-uterine correction improves the neurological prognosis outcome of affected newborn infants when comparing prenatal with post-natal correction (6) .…”

Section: Introductionmentioning

confidence: 99%

Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep

Herrera

Leme

Valente

et al. 2012

Einstein (São Paulo)

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Objective: To compare the classical neurosurgical technique with a new simplified technique for prenatal repair of a myelomeningocelelike defect in sheep. Methods: A myelomeningocele-like defect (laminectomy and dural excision) was created in the lumbar region on day 90 of gestation in 9 pregnant sheep. Correction technique was randomized. In Group 1 the defect was corrected using the classic neurosurgical technique of three-layer suture (dura mater, muscle and skin closure) performed by a neurosurgeon. In Group 2, a fetal medicine specialist used a biosynthetic cellulose patch to protect the spinal cord and only the skin was sutured above it. Near term (day 132 of gestation) fetuses were sacrificed for pathological analysis. Results: There were two miscarriages and one maternal death. In total, six cases were available for pathological analysis, three in each group. In Group 1, there were adherence of the spinal cord to the scar (meningo-neural adhesion) and spinal cord architecture loss with posterior funiculus destruction and no visualization of grey matter. In Group 2, we observed in all cases formation of a neo-dura mater, separating the nervous tissue from adjacent muscles, and preserving the posterior funiculus and grey matter. Conclusion: The new simplified technique was better than the classic neurosurgical technique. It preserved the nervous tissue and prevented the adherence of the spinal cord to the scar. This suggests the current technique used for the correction of spina bifida in humans may need to be reassessed. de ovelhas. Métodos: Em 9 fetos, foi criado um defeito semelhante à mielomeningocele (laminectomia e excisão de dura-máter) no 90° dia de gestação. O tipo de correção foi randomizado. No Grupo 1, o defeito foi corrigido usando a técnica neurocirúrgica clássica, com a sutura de três camadas (dura-máter, músculo e pele), realizada por um neurocirurgião. No Grupo 2, um especialista em Medicina Fetal utilizou a técnica simplificada, colocando um fragmento de celulose biossintética sobre a medula e suturando apenas da pele sobre a celulose. Próximo ao termo da gestação (132 dias), os fetos foram sacrificados para análise anatomopatológica. Resultados: Ocorreram dois casos de aborto e uma morte materna, restando seis casos para avaliação -três em cada grupo. No Grupo 1, todos os casos mostraram aderência da medula à cicatriz (meningoadesão) e perda da arquitetura medular, com destruição do funículo posterior e perda da visualização da substância cinzenta. No Grupo 2, observou-se, em todos os casos, a formação de uma neodura-máter, separando o tecido nervoso do músculo adjacente, sendo que o funículo posterior e a substância cinzenta estavam preservados. Conclusão: A técnica simplificada foi superior à neurocirúrgica, com maior preservação da medula e evitando as aderências do tecido nervoso. Os presentes achados sugerem que a técnica utilizada atualmente na correção de mielomeningocele em fetos humanos deva ser reavaliada. Keywords

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“…Histologic findings support the idea that the exposed spinal cord is vulnerable to damage by physical trauma as the cord contacts the uterine wall. Physical trauma, and the toxic effects of amniotic fluid and meconium to the exposed spinal cord have been reported (18)(19)(20). Fetal lower limb movements have been described in fetuses with MMC at 16-17 weeks (21).…”

Section: Introductionmentioning

confidence: 99%

Prenatal intervention for urinary obstruction and myelomeningocele

2004

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Widespread use of ultrasonography has resulted in an increase in the recognition of fetal hydronephrosis. The enthusiasm that accompanied early interventions has been tempered by the experience and results obtained over the past 2 decades. The goal has remained the same: to identify patients with serious prenatal obstruction and to identify those which may benefit from intervention. Myelomeningocele remains a devastating congenital anomaly. Fetal and experimental studies suggested that patients with myelomeningocele could benefit from prenatal intervention. Advances in technology and perinatal management have made intervention for more complex malformations such as myelomeningocele possible. This article will review current knowledge and will detail rational management for the management of prenatal hydronephrosis. The current state of antenatal myelomeningocele repair and the urologic implications will be described as well.

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The spinal cord lesion in human fetuses with myelomeningocele: Implications for fetal surgery

Cited by 203 publications

References 8 publications

In utero repair of myelomeningocele with autologous amniotic membrane in the fetal lamb model

In utero repair of myelomeningocele with autologous amniotic membrane in the fetal lamb model

Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep

Prenatal intervention for urinary obstruction and myelomeningocele

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