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Vol. 31, No. 4, 1999
Issue release date: October 1999
Section title: Original Paper
Pediatr Neurosurg 1999;31:183–188
(DOI:10.1159/000028859)

Effect of Intrauterine Myelomeningocele Repair on Central Nervous System Structure and Function

Tulipan N.a · Bruner J.P.c · Hernanz-Schulman M.b · Lowe L.H.b · Walsh W.F.d · Nickolaus D.a · Oakes W.J.e
Departments of aNeurosurgery, bRadiology, cObstetrics and Gynecology, and dNeonatology, Vanderbilt University Medical Center, Nashville, Tenn.; eDepartment of Neurosurgery, University of Alabama, Birmingham, Ala., USA

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Published online: 1/20/2000
Issue release date: October 1999

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 1

ISSN: 1016-2291 (Print)
eISSN: 1423-0305 (Online)

For additional information: http://www.karger.com/PNE

Abstract

Background: It has been postulated that intrauterine myelomeningocele repair might improve neurologic outcome in patients with myelomeningocele. A total of 59 such procedures have been performed at Vanderbilt University. Preliminary results suggested that the degree of hindbrain herniation is reduced by intrauterine repair. In an attempt to further quantify the possible benefits of this surgery, a subset of these patients was brought back to Vanderbilt for study. Methods: A group of 26 patients who had undergone intrauterine myelomeningocele repair underwent an extensive evaluation which included manual muscle testing, MR imaging and precise determination of the anatomic level of their lesions as well as multiple other tests. The results of this analysis were compared to those in 2 groups of historical controls. Results: In this group of patients intrauterine myelomeningocele repair substantially reduced the incidence of moderate to severe hindbrain herniation (4 vs. 50%). The incidence of shunt-dependent hydrocephalus was more modestly reduced (58 vs. 92%). The average level of leg function closely matched the average anatomic level of the lesion in both the fetal surgery and control groups. Conclusion: The most dramatic effect of intrauterine repair appears to be on hindbrain herniation. A less dramatic, but significant, reduction in shunt-dependent hydrocephalus is also seen. Prospective patients should be cautioned not to expect improvement in leg function as the result of this surgery. The potential benefits of surgery must be carefully weighed against the potential risks of prematurity.

© 2000 S. Karger AG, Basel


  

Article Information

Received: Received: September 16, 1999
Accepted: October 13, 1999
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 1, Number of References : 14

  

Publication Details

Pediatric Neurosurgery
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. 31, No. 4, Year 1999 (Cover Date: October 1999)

Journal Editor: D.G. McLone, Chicago, Ill.
ISSN: 1016–2291 (print), 1423–0305 (Online)

For additional information: http://www.karger.com/journals/pne


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Published online: 1/20/2000
Issue release date: October 1999

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 1

ISSN: 1016-2291 (Print)
eISSN: 1423-0305 (Online)

For additional information: http://www.karger.com/PNE


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