Improvement in Hindbrain Herniation Demonstrated by Serial Fetal Magnetic Resonance Imaging Following Fetal Surgery for Myelomeningocele

Sutton, Leslie N.

doi:10.1001/jama.282.19.1826

Cited by 408 publications

(253 citation statements)

References 27 publications

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“…4 The clinical outcomes of in utero surgery have suggested clear improvement in some neurological lesions, namely in the reversal of ectopic cerebellar tonsils of the MMC-associated Chiari malformation, decreasing it from 95 to 38%, with a consequent reduction in the need for a ventricular shunt from 91 to 59%. 3,[31][32][33][34] In contrast, deficits in the lower limbs and in urodynamic function in patients submitted to MMC correction, through either fetal or classic postnatal surgery, were similar to those of controls. 14,30,27 Attending to these data, the potential benefits of in utero repair of MMC are under scrutiny in a randomized trial designed to compare the clinical outcomes of patients with MMC treated with either fetal or postnatal surgery.…”

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confidence: 83%

Vascular and apoptotic changes in the placode of myelomeningocele mice during the final stages of in utero development

Reis

Correia‐Pinto

Monteiro

et al. 2008

PED

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Object Myelomeningocele (MMC) is a primary neurulation defect that is associated with devastating neurological disabilities in affected newborns. To better characterize the in utero neurodegenerative process of MMC, the authors investigated the changes in vascular organization, apoptosis, and the presence of inflammatory cells during gestation by using a mutant mouse model of MMC. Methods The curly tail/loop tail (ct/lp) mutant mouse model of MMC was chosen to obtain fetuses at different stages of gestation. Mouse fetuses harboring MMC were harvested by caesarean section at embryonic Days 14.5, 16.5, and 18.5 (complete mouse gestation at 19 days, 6 mice/group); littermate fetuses with the same gestational age but without an MMC were used as controls. Samples of the MMC placode or normal spinal cord were stained for immunocytochemical labeling with caveolin antibody (endothelium marker) and activated caspase-3 antibody (apoptosis marker). Samples were morphometrically analyzed with a computer-assisted image analyzer. Results The MMC mice presented with an increase in vascular density from embryonic Days 16.5–18.5 and an enhanced number of apoptotic cells at embryonic Day 18.5, compared with controls. There were scarce signals of an inflammatory reaction in the MMC placode, as a few infiltrating neutrophils were seen only at embryonic Day 18.5. Conclusions Fetal placodes in MMC mice showed evidence of increased vascular density since embryonic Day 16.5 and increased apoptosis at embryonic Day 18.5. These new data support the view that in utero changes of the MMC placode, occurring during the last stages of gestation, contribute to the neuropathological manifestations in full-term newborns with MMC.

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confidence: 83%

Vascular and apoptotic changes in the placode of myelomeningocele mice during the final stages of in utero development

Reis

Correia‐Pinto

Monteiro

et al. 2008

PED

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“…MRI is also useful in visualizing posterior fossa structures in cases of Chiari II malformation. This is helpful in the in utero assessment of fetuses after surgery for neural tube defects (71). However, for the majority of well-visualized spinal neural tube defects in which fetal surgery is not being performed, MR has limited potential to influence care (64).…”

Section: Cns Anomaliesmentioning

confidence: 99%

“…In patients undergoing surgery for neural tube defects, MRI is helpful in characterizing the Chiari malformation, since the amount of cerebellar herniation is easily followed on serial MRI (71).…”

Section: The Fetal Surgery Patientmentioning

confidence: 99%

Obstetric MRI

Levine

2006

Magnetic Resonance Imaging

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Ultrasound is the imaging modality of choice for pregnant patients. However, MRI is increasingly utilized in patients in whom the sonographic diagnosis is unclear. These include maternal conditions unique to pregnancy such as ectopic pregnancy, placenta accreta, and uterine dehiscence. MRI is also being increasingly utilized in the assessment of abdominopelvic pain in pregnancy, in particular in assessment for appendicitis. Fetal MRI is performed to assess central nervous system (CNS) abnormalities and patients who are considering fetal surgery for conditions such as neural tube defects, congenital diaphragmatic hernia, and masses that obstruct the airway. In the future, functional MRI and fetal volumetry may provide additional information that can aid in our care of complicated pregnancies.

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“…Because the Management of Myelomeningocele randomized controlled trial has shown that prenatal surgery for myelomeningoceles reduces the need for shunting and may improve neurologic function in some patients, MR imaging has become imperative in evaluating these fetuses before intervention. [4][5][6] Subependymal gray matter heterotopias (SEH) are seen in a relatively high proportion of children with Chiari II malformation, with a reported incidence as high as 30%. 7 Although the exact implications in this subset of patients are still under investigation, ample reports in the literature describe the clinical relevance of SEH.…”

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confidence: 99%

Evaluation of Subependymal Gray Matter Heterotopias on Fetal MRI

Nagaraj

Peiró

Bierbrauer

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Subependymal grey matter heterotopias are seen in a high proportion of children with Chiari II malformation and are potentially clinically relevant. However, despite its growing use, there is little in the literature describing its detection on fetal MRI. Our aim was to evaluate the accuracy in diagnosing subependymal gray matter heterotopias in fetuses with spinal dysraphism on fetal MR imaging.

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Improvement in Hindbrain Herniation Demonstrated by Serial Fetal Magnetic Resonance Imaging Following Fetal Surgery for Myelomeningocele

Abstract: In this series of patients, fetal myelomeningocele closure resulted in improvement in hindbrain herniation as demonstrated by serial MRI scans.

Cited by 408 publications

References 27 publications

Vascular and apoptotic changes in the placode of myelomeningocele mice during the final stages of in utero development

Vascular and apoptotic changes in the placode of myelomeningocele mice during the final stages of in utero development

Obstetric MRI

Evaluation of Subependymal Gray Matter Heterotopias on Fetal MRI

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