Perinatal motor behaviour and neurological outcome in spina bifida aperta

Sival, Deborah A; Begeer, J.H.; Staal-Schreinemachers, A L; Vos-Niel, J. M. E.; Beekhuis, J. R.; Prechtl, H.F.R.

doi:10.1016/s0378-3782(97)00090-x

Cited by 124 publications

(93 citation statements)

References 18 publications

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“…Movement in the lower limbs may be lost, and hindbrain herniation and hydrocephalus may worsen during fetal gestation. 7,8 In studies in animals, prenatal coverage of a spina bifidalike lesion preserved neurologic function and improved hindbrain herniation. [9][10][11][12][13] These data suggest a "two-hit" hypothesis in which the final neurologic deficit results from a combination of failure of neural-tube formation and spinal cord injury resulting from prolonged exposure of neural elements to the intrauterine environment.…”

mentioning

confidence: 99%

A Randomized Trial of Prenatal Versus Postnatal Repair of Myelomeningocele

Adzick

Thom

Spong

et al. 2012

Obstetric Anesthesia Digest

112

192

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mentioning

confidence: 99%

A Randomized Trial of Prenatal Versus Postnatal Repair of Myelomeningocele

Adzick

Thom

Spong

et al. 2012

Obstetric Anesthesia Digest

112

192

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“…The rationale for fetal treatment is based on the ‘two-hit' hypothesis, where the first ‘hit' is the primary failure of neurulation, and the second ‘hit' is the injury to exposed neural elements caused by exposure to amniotic fluid and mechanical trauma within the amniotic space [3]. Most experimental and clinical evidence indicates that the majority of neural damage is caused by the second hit, leading to a compelling rationale for the prenatal treatment of MMC [4,5,6,7,8]. Experimental data from the sheep model of MMC confirmed the acquired pathophysiology of MMC [9] and demonstrated that prenatal surgical closure of the defect prevents damage to the cord [10,11,12].…”

Section: Rationale For Prenatal Surgical Closure Of Myelomeningocelementioning

confidence: 99%

Tissue Engineering Strategies for Fetal Myelomeningocele Repair in Animal Models

2014

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Myelomeningocele (MMC), the most severe form of spina bifida, is a common and devastating malformation. Over two decades of experimental work in animal models have led to the development and clinical application of open fetal surgery for the repair of the MMC defect. This approach offers improved neurofunctional outcomes and is now a clinical option for the management of prenatally diagnosed MMC in selected patients. However, there are still opportunities for further improvement in the prenatal treatment of MMC. A less invasive approach would allow for an application earlier in gestation, with a reduction in maternal and fetal risks and the potential for reduced neurological injury. Tissue engineering offers a realistic and appealing alternative approach for the prenatal treatment of MMC. This review discusses the rationale for tissue engineering in MMC, addresses recent experimental progress and describes potential future directions.

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“…9 Serial ultrasound images of fetuses with myelomeningocele suggest that central and peripheral nerve damage is progressive over time. 10,11 In animal models, fetal closure of a myelomeningocele results in improved neurological function. 12 This is thought to be due to decreased exposure of neural tissue to the intrauterine environment, resulting in neural tissue preservation.…”

Section: Introductionmentioning

confidence: 99%

Anesthesia for In Utero Repair of Myelomeningocele

Ferschl

Ball

Lee

et al. 2014

Survey of Anesthesiology

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Recently published results suggest that prenatal repair of fetal myelomeningocele is a potentially preferable alternative when compared to postnatal repair. In this article, the pathology of myelomeningocele, unique physiologic considerations, perioperative anesthetic management, and ethical considerations of open fetal surgery for prenatal myelomeningocele repair are discussed. Open fetal surgeries have many unique anesthetic issues such as inducing profound uterine relaxation, vigilance for maternal or fetal blood loss, fetal monitoring, and possible fetal resuscitation. Postoperative management, including the requirement for postoperative tocolysis and maternal analgesia are also reviewed. The success of intrauterine myelomeningocele repair relies on a well-coordinated multidisciplinary approach. Fetal surgery is an important topic for anesthesiologists to understand, as the number of fetal procedures is likely to increase as new fetal treatment centers are opened across the United States.

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Perinatal motor behaviour and neurological outcome in spina bifida aperta

Cited by 124 publications

References 18 publications

A Randomized Trial of Prenatal Versus Postnatal Repair of Myelomeningocele

A Randomized Trial of Prenatal Versus Postnatal Repair of Myelomeningocele

Tissue Engineering Strategies for Fetal Myelomeningocele Repair in Animal Models

Anesthesia for In Utero Repair of Myelomeningocele

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