Late Gestational Intrauterine Myelomeningocele Repair Does Not Improve Lower Extremity Function

@article{Tubbs2003LateGI,
  title={Late Gestational Intrauterine Myelomeningocele Repair Does Not Improve Lower Extremity Function},
  author={R. Shane Tubbs and Melissa Renee Chambers and Matthew Smyth and Alfred A. Bartolucci and Joseph P. Bruner and Noel B. Tulipan and Walter Jerry Oakes},
  journal={Pediatric Neurosurgery},
  year={2003},
  volume={38},
  pages={128 - 132}
}
Objective: To determine whether intrauterine myelomeningocele repair performed at between 20 and 28 weeks gestation improves lower extremity function (LEF). Methods: Thirty-seven consecutive patients who had undergone intrauterine repair of their myelomeningocele at Vanderbilt University Medical Center had their lower extremity function and radiographic level (first defective vertebral level) compared to these same parameters in 40 controls who had undergone traditional postgestational repair… Expand
In utero Repair of Myelomeningocele: Rationale, Initial Clinical Experience and a Randomized Controlled Prospective Clinical Trial
TLDR
Initial results suggest that the surgical repair of MMC before 25 weeks of gestation may preserve neurological function, reverse the hindbrain herniation of the Arnold-Chiari II malformation, and obviate the need for postnatal placement of a ventriculoperitoneal shunt. Expand
Prenatal covering of the spinal cord decreases neurologic sequelae in a myelomeningocele model.
TLDR
Prenatal covering of the spinal cord prevents central and peripheral neurologic deterioration in this animal model of myelomeningocele. Expand
Improvement of motor function and decreased need for postnatal shunting in children who had undergone intrauterine myelomeningocele repair.
TLDR
It was observed that an improvement of motor function and decreased need for postnatal shunting in the 6 children who had undergone intrauterine myelomeningocele repair significantly improved motor function. Expand
Fetal surgery for myelomeningocele is effective: a critical look at the whys
TLDR
Despite the fact that in utero repair of MMC is not a complete cure and not free of risk for both mother and fetus, current data clearly demonstrate that open fetal–maternal surgery is to be recommended as novel standard of care when pregnancies are to be continued and when respective criteria for the intervention before birth are met. Expand
Intrauterine myelomeningocele repair Postnatal results and follow-up at 3.5 years of age — initial experience from a single reference service in Brazil
TLDR
Antenatal surgical repair of MMC reduced the need for postnatal shunt placements and the cognitive development of most children at 3.5 years was normal, and antenatal surgery seemed to improve lower limb motor function in these cases. Expand
Fetal Spina Bifida Repair – Current Trends and Prospects of Intrauterine Neurosurgery
TLDR
Preliminary findings suggest a reduced incidence of shunt-dependent hydrocephalus, as well as an improvement in hindbrain herniation, in patients treated with intrauterine MMC repair in the USA. Expand
The timing of primary neurosurgical repair significantly affects neurogenic bladder prognosis in children with myelomeningocele.
TLDR
The timing of primary neurosurgical repair has a significant impact on neurogenic bladder prognosis in children with myelomeningocele and closure of the spinal lesion on the first day of life seems to provide the best chance for favorable lower urinary tract function. Expand
Lower Extremity Neuromotor Function and Short-Term Ambulatory Potential following in utero Myelomeningocele Surgery
TLDR
F fetal myelomeningocele surgery in this highly selective population results in better than predicted LENF at birth and short-term ambulatory status, however, fMMC toddlers continue to demonstrate deficits in movement coordination that are characteristic for children with spina bifida. Expand
Fetal Surgery for Myelomeningocele
Myelomeningocele (MMC), a nonlethal neural tube defect, occurs in approximately 1 in 2000 live births in the United States. Developmentally, it arises early in gestation at about the third week andExpand
The Role of Fetal Neurosurgery in Spina Bifida
TLDR
Myelomeningocele is a nonlethal form of neural tube defect that results from failure of the neural tube to fuse during early embryogenesis and is principally attributable to the hindbrain herniation observed in Chiari malformation and to the renal failure observed in neurogenic bladder dysfunction. Expand
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References

SHOWING 1-10 OF 17 REFERENCES
Effect of Intrauterine Myelomeningocele Repair on Central Nervous System Structure and Function
TLDR
The most dramatic effect of intrauterine repair appears to be on hindbrain herniation, while a less dramatic, but significant, reduction in shunt-dependent hydrocephalus is also seen. Expand
In utero repair of experimental myelomeningocele saves neurological function at birth.
TLDR
Findings show that timely in utero repair of developing experimental MMC stops the otherwise ongoing process of spinal cord destruction and "rescues" neurological function by the time of birth. Expand
Myelomeningocele before birth.
TLDR
It is observed that almost all embryos with diffuse and cervical myeloschisis or with holoprosencephaly are extruded before birth by spontaneous abortion, implying that myelomeningocele is induced by non-closure of the neural tube, not by rupture once it was closed. Expand
The paralysis associated with myelomeningocele: clinical and experimental data implicating a preventable spinal cord injury.
TLDR
A "two-hit" hypothesis to explain the paralysis seen in children with myelomeningocele: congenital myelodysplasia complicated by an intrauterine spinal cord injury andIntrauterine protection of the exposed spinal cord might prevent some or all of the paralysis. Expand
Myelomeningocele: a Progressive Intra‐uterine Disease
TLDR
The conclusion is that myelomeningocele is the result of progressive intra‐uterine disease which begins with pathological hydromyelia and culminates in rupture of the unsupported spinal cord as a result of maldevelopment of associated dermal tissue. Expand
Prenatally detected myelomeningoceles: sonographic accuracy in estimation of the spinal level.
TLDR
The authors conclude that ultrasonography can, in most cases, allow accurate prediction of the level of the spina bifida lesion and the severity of neuromotor handicap in children with prenatal diagnoses of myelomeningocele. Expand
Intrauterine treatment of spina bifida: primate model.
  • M. Michejda
  • Medicine
  • Zeitschrift fur Kinderchirurgie : organ der Deutschen, der Schweizerischen und der Osterreichischen Gesellschaft fur Kinderchirurgie = Surgery in infancy and childhood
  • 1984
A spina-bifida-like condition was induced in 8 Macaca mulatta fetuses by intra-uterine lumbar laminectomy (L3-L5) followed by displacement of the spinal cord from the central canal. This conditionExpand
FUNCTIONAL MOTOR OUTCOME IN CHILDREN WITH MYELOMENINGOCELE: CORRELATION WITH ANATOMIC LEVEL ON PRENATAL ULTRASOUND
TLDR
Prenatal anatomic level accurately predicted neuromotor level and functional motor outcome in 12 of the children and was a better predictor than motor level at birth. Expand
Intrauterine repair of experimental surgically created dysraphism.
TLDR
The results of intrauterine treatment of experimental dysraphism in the fetal rat and the fetal pig confirm the earlier findings and suggest that both physical trauma and toxic injury may contribute to the spinal cord injury. Expand
Intrauterine repair of experimental surgically created dysraphism.
TLDR
The results of intrauterine treatment of experimental dysraphism in the fetal rat and the fetal pig confirm the earlier findings and suggest that both physical trauma and toxic injury may contribute to the spinal cord injury. Expand
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