Effect of Intrauterine Myelomeningocele Repair on Central Nervous System Structure and Function
| Autor: | W. F. Walsh, Marta Hernanz-Schulman, Lisa H. Lowe, Nickolaus D, Noel Tulipan, Joseph P. Bruner, Oakes Wj |
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| Rok vydání: | 1999 |
| Předmět: |
Diagnostic Imaging
Male medicine.medical_specialty Meningomyelocele medicine.medical_treatment Central nervous system disease Lesion Postoperative Complications Pregnancy medicine Humans Fetus business.industry Fetal surgery Incidence (epidemiology) Infant Newborn Infant General Medicine medicine.disease Magnetic Resonance Imaging Cerebrospinal Fluid Shunts Hydrocephalus Surgery Fetal Diseases Treatment Outcome In utero Pediatrics Perinatology and Child Health Female Neurology (clinical) medicine.symptom business Complication Follow-Up Studies |
| Zdroj: | Pediatric Neurosurgery. 31:183-188 |
| ISSN: | 1423-0305 1016-2291 |
| DOI: | 10.1159/000028859 |
| Popis: | Background: It has been postulated that intrauterine myelomeningocele repair might improve neurologic outcome in patients with myelomeningocele. A total of 59 such procedures have been performed at Vanderbilt University. Preliminary results suggested that the degree of hindbrain herniation is reduced by intrauterine repair. In an attempt to further quantify the possible benefits of this surgery, a subset of these patients was brought back to Vanderbilt for study. Methods: A group of 26 patients who had undergone intrauterine myelomeningocele repair underwent an extensive evaluation which included manual muscle testing, MR imaging and precise determination of the anatomic level of their lesions as well as multiple other tests. The results of this analysis were compared to those in 2 groups of historical controls. Results: In this group of patients intrauterine myelomeningocele repair substantially reduced the incidence of moderate to severe hindbrain herniation (4 vs. 50%). The incidence of shunt-dependent hydrocephalus was more modestly reduced (58 vs. 92%). The average level of leg function closely matched the average anatomic level of the lesion in both the fetal surgery and control groups. Conclusion: The most dramatic effect of intrauterine repair appears to be on hindbrain herniation. A less dramatic, but significant, reduction in shunt-dependent hydrocephalus is also seen. Prospective patients should be cautioned not to expect improvement in leg function as the result of this surgery. The potential benefits of surgery must be carefully weighed against the potential risks of prematurity. |
| Databáze: | OpenAIRE |
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