Fetal Surgery for Myelomeningocele and the Incidence of Shunt-Dependent Hydrocephalus

Bruner, Joseph P.; Tulipan, Noel; Paschall, Ray L.; Boehm, Frank H.; Walsh, William F.; Silva, Sandra R.; Hernanz‐Schulman, Marta; Lowe, Lisa H.; Reed, George W.

doi:10.1097/00006254-200006000-00004

Cited by 115 publications

(169 citation statements)

References 0 publications

Supporting

Mentioning

148

Contrasting

Unclassified

Order By: Relevance

“…No functional improvements have been found in the lower extremities or bladder and bowel functions, but the need for shunt operations is reported to be significantly reduced. As this surgery has so far also led to an increased rate of early delivery and mortality, it is not generally recommended (Bruner et al, 1999;Farmer et al, 2003).…”

Section: Treatment Of Hydrocephalus Todaymentioning

confidence: 99%

Behavioural problems and autism in children with hydrocephalus

Lindquist

Carlsson

Persson

et al. 2006

Eur Child Adolesc Psychiatry

View full text Add to dashboard Cite

Aims: The main objective of this thesis was to explore the cognitive and behavioural consequences of hydrocephalus in children born at term and preterm, with or without myelomeningocele (MMC) and with or without concomitant neurological impairments, such as cerebral palsy (CP), epilepsy or learning disabilities. Material and methods:From a population-based cohort of all 107 children with hydrocephalus born in [1989][1990][1991][1992][1993] 73 of the surviving children were assessed with intelligence tests and most of them also using behavioural and autism rating scales. Thirty-six of 47 (77%) children with an IQ of ≥ 70 and eight children with MMC but no hydrocephalus were assessed with a neuropsychological test battery (NIMES) and compared with age-and gender-matched controls. Results:One-third of the children were normally gifted (IQ > 85), another 30% had a low-average IQ of 70-84 and 37% had learning disabilities (IQ < 70). An IQ of < 70 was found in 42% of children without MMC and in 29% of those with MMC. Children born preterm had a lower IQ than those born at term. Children with CP and/or epilepsy had significantly lower IQ scores than those without these impairments. Parents rated 67% and teachers 39% of the children as having behavioural problems. Learning disabilities increased the risk significantly. Almost all the children with CP and/or epilepsy had behavioural problems. Learning disabilities, CP and epilepsy significantly increased the risk of autistic symptoms, which were present in 13 %, in 4 % of those with MMC and in 20 % of those without MMC. Children with hydrocephalus both with and without MMC and with an IQ of > 70 performed significantly less well than controls on learning, memory and executive functions but not on registration skills. There were no differences between children with hydrocephalus in combination with MMC and those without MMC, whereas children with MMC but no hydrocephalus and normal intelligence performed as well as controls on all the neuropsychological functions. Conclusions:The majority of children with hydrocephalus had learning disabilities or a low-average IQ, as well as behavioural problems, and some had autistic symptoms. Despite average or slightly below average intelligence, children with hydrocephalus had major difficulties with learning and memory and with executive functions, regardless of the aetiology of the hydrocephalus. Only MMC did not appear to influence cognitive and neuropsychological outcome as much as the brain lesion causing or caused by the hydrocephalus.

show abstract

Section: Treatment Of Hydrocephalus Todaymentioning

confidence: 99%

Behavioural problems and autism in children with hydrocephalus

Lindquist

Carlsson

Persson

et al. 2006

Eur Child Adolesc Psychiatry

View full text Add to dashboard Cite

show abstract

“…The simplified technique also allowed better preservation of the spinal cord cytoarchitecture. Several previous studies on the intrauterine correction of myelomeningocele had already suggested that prenatal correction led to a better preservation of the spinal cord and better clinical results (10)(11)(12)(13) .The MOMS study demonstrated that the intrauterine correction reduced the need of ventriculoperitoneal shunting from 82 to 40% comparing postnatal with prenatal correction, respectively. That study also showed better cognitive and motor skills up to 30 months of age in the group submitted to prenatal correction (6) .…”

Section: Discussionmentioning

confidence: 93%

“…That study also showed better cognitive and motor skills up to 30 months of age in the group submitted to prenatal correction (6) . As to the uterine approach, some studies showed that open surgery greatly increased the risk of premature labor and maternal complications (6,10,12) . In the MOMS study, average gestational age at birth was 34.1 weeks in cases of prenatal surgery versus 37.3 weeks in postnatal surgery.…”

Section: Discussionmentioning

confidence: 99%

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

Herrera

Leme

Valente

et al. 2012

Einstein (São Paulo)

View full text Add to dashboard Cite

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

show abstract

“…Vários estudos para correção intrauterina de mielomeningocele, sugeriam que a correção pré-natal levava a uma menor destruição da medula exposta ao líquido amniótico e melhores resultados clínicos [56][57][58][59] . O estudo do MOMS, realizado em humanos, corroborou esta teoria demonstrando que a correção intra-uterina reduziu a necessidade de colocação de shunt ventrículo peritoneal de 82% para 40%, quando se comparou a correção pós-natal com a pré-natal, respectivamente.…”

Section: Análise Estatísticaunclassified

“…Alguns estudos já haviam demonstrado que a cirurgia intra-uterina, realizada a céu aberto, aumenta o risco de trabalho de parto prematuro e de complicações maternas, tais como, deiscência uterina e edema agudo de pulmão 24,56,59 . O estudo MOMS mostrou que a idade gestacional média ao nascimento foi de 34,1 semanas nos casos operados antes, comparada a 37,3 semanas, quando a cirurgia foi realizada após o nascimento.…”

Section: Análise Estatísticaunclassified

Comparação entre duas técnicas cirúrgicas para correção intra-uterina de meningomielocele em feto de ovelha

Herrera¹

View full text Add to dashboard Cite

Fetal Surgery for Myelomeningocele and the Incidence of Shunt-Dependent Hydrocephalus

Cited by 115 publications

References 0 publications

Behavioural problems and autism in children with hydrocephalus

Behavioural problems and autism in children with hydrocephalus

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

Comparação entre duas técnicas cirúrgicas para correção intra-uterina de meningomielocele em feto de ovelha

Contact Info

Product

Resources

About