Fetal myelomeningocele repair: short-term clinical outcomes - 28/08/11
, Leslie N Sutton, MD, Natalie Rintoul, MD, Timothy M Crombleholme, MD, Alan W Flake, MD, Lori J Howell, RN, MS, Holly L Hedrick, MD, R.Douglas Wilson, MD, N.Scott Adzick, MD
Reprint requests: Mark Paul Johnson, MD, Center for Fetal Diagnosis and Treatment, 5th Floor Wood Center, Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104.Abstract |
OBJECTIVE: The study was undertaken to evaluate short-term clinical outcomes with antenatal myelomeningocele (MMC) repair.
STUDY DESIGN: Retrospective review of 50 fetuses that underwent open fetal MMC closure was performed. Inclusion criteria included less than 26 weeks' gestation, thoracic to S1 level defect, absent clubfoot deformity, Arnold-Chiari malformation, ventriculomegaly less than 17 mm, normal karyotype, and no other anomalies.
RESULTS: Perinatal survival was 94% (47/50 fetuses). Mean age at delivery was 34 weeks 3 days. All fetuses demonstrated reversal of hindbrain herniation. Forty-three percent of the 50 fetuses have required ventriculoperitoneal shunting compared with 100% thoracic, 88% lumbar, and 68% sacral (85% overall) in 297 historic controls. Better-than-predicted leg function was seen in 57% of thoracic and lumbar level lesion patients.
CONCLUSION: Early experience with fetal MMC repair suggests a decreased need for ventriculoperitoneal shunting, arrest or slowing of progressive ventriculomegaly, and consistent resolution of hindbrain herniation. However, further long-term follow-up is needed to evaluate neurodevelopment and bladder and bowel function.
Le texte complet de cet article est disponible en PDF.Keywords : Fetal surgery, spina bifida, myelomeningocele, ventriculoperitoneal shunting
Plan
Vol 189 - N° 2
P. 482-487 - août 2003 Retour au numéro
Article précédent
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