Background: Evidence accumulating over the last 10 years suggests that the exposed spinal cord tissue in a myelomeningocele sustains a secondary injury as the result of prolonged exposure to the intrauterine environment. These data suggest that early closure of the myelomeningocele sac might prevent such injury and in turn improve the neurologic outcome in the affected infant. Methods: Three patients with fetuses carrying the ultrasonic diagnosis of myelomeningocele elected to enter a study of the feasibility of repairing myelomeningocele in utero. At approximately 28 weeks of gestation each patient underwent laparotomy and hysterotomy, thus exposing the myelomeningocele defect. The defect was closed in a routine surgical fashion, and the hysterotomy was then closed. Results: The 3 patients recovered from surgery without incident. Early premature contractions subsided, and they were discharged by the 5th postoperative day. At between 33 and 36 weeks of gestation, each infant was delivered via cesarean section. The observed neurologic deficits were within the range expected from the anatomic level of the defects. Two of the infants have not required ventriculoperitoneal shunting. Conclusions: This limited series of patients suggests that myelomeningocele can be repaired in utero with minimal morbidity to either the mother or her fetus. A larger study will be needed to substantiate this low morbidity and to determine the extent of any neurologic benefit of early surgery.
Noel Tulipan, MD
Department of Neurosurgery, T-4224, Medical Center North
Vanderbilt University Medical Center, Nashville, TN 37232 (USA)
Tel. +1 615 322 6875, Fax +1 615 343 8343
Received: Received: March 19, 1998
Accepted: March 31, 1998
Number of Print Pages : 4
Number of Figures : 0, Number of Tables : 0, Number of References : 24
Founded 1985 by E.B. Hendrick and D.H. Reigel; Editor-in-Chief 1992–1996: F.J. Epstein
Official Journal of the American Society of Pediatric Neurosurgeons (ASPN)
Vol. 28, No. 4, Year 1998 (Cover Date: April 1998)
Journal Editor: D.G. McLone, Chicago, Ill.
ISSN: 1016–2291 (print), 1423–0305 (Online)
For additional information: http://www.karger.com/journals/pne
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