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Table of Contents
Vol. 38, No. 3, 2003
Issue release date: March 2003
Section title: Original Paper
Pediatr Neurosurg 2003;38:128–132
(DOI:10.1159/000068818)

Late Gestational Intrauterine Myelomeningocele Repair Does Not Improve Lower Extremity Function

Tubbs R.S.a,c · Chambers M.R.d · Smyth M.D.c · Bartolucci A.A.b · Bruner J.P.e · Tulipan N.d · Oakes W.J.c
Departments of aCell Biology, bBiostatistics, University of Alabama at Birmingham, and cPediatric Neurosurgery, Children’s Hospital, Birmingham, Ala.; dDepartments of Neurosurgery and eObstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tenn., USA

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: September 04, 2002
Accepted: November 04, 2002
Published online: March 03, 2003
Issue release date: March 2003

Number of Print Pages: 5
Number of Figures: 4
Number of Tables: 1

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

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

Abstract

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 of their myelomeningocele at the Children’s Hospital in Birmingham, Ala., USA. Results: Of all 77 patients (controls and study group), 13 had a LEF that matched their radiographic level, 27 had a LEF that was rostral to their radiographic level, and 37 had a LEF that was caudal to their radiographic level. Further stratification revealed that for the intrauterine repaired myelomeningoceles, 11% had no difference between LEF and radiographic level, 43% had a LEF that was rostral to their radiographic level, and 46% had a LEF that was caudal to their radiographic level. For those closed in a traditional manner, LEF matched their radiographic level, was rostral to their radiographic level, and was caudal to their radiographic level in 22.5%, 27.5%, and 50% respectively. However, the overall mean differences between institutions produced a p-value of 0.2026 (paired t-test). Conclusions: Although the current timing of intrauterine myelomeningocele repair has been found to lessen the degree of herniation of the rhombencephalon and reduce the incidence of shunt-dependent hydrocephalus, it does not statistically improve LEF. Parents should be advised of these findings prior to surgical intervention so as to focus their expectations.

© 2003 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: September 04, 2002
Accepted: November 04, 2002
Published online: March 03, 2003
Issue release date: March 2003

Number of Print Pages: 5
Number of Figures: 4
Number of Tables: 1

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

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


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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