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
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 7076
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
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
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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