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Vol. 38, No. 1, 2003
Issue release date: January 2003
Section title: Original Paper
Pediatr Neurosurg 2003;38:27–33
(DOI:10.1159/000067560)

The Effect of Intrauterine Myelomeningocele Repair on the Incidence of Shunt-Dependent Hydrocephalus

Tulipan N. · Sutton L.N. · Bruner J.P. · Cohen B.M. · Johnson M. · Adzick N.S.
Departments of aNeurosurgery and bObstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tenn., cDepartment of Surgery, dDivision of Biostatistics and Epidemiology, eThe Center for Fetal Diagnosis and Treatment, The Children’s Hospital of Philadelphia, The University of Pennsylvania Medical School, Philadelphia, Pa., USA

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 6/6/2002
Accepted: 8/6/2002
Published online: 12/19/2002

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 6

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

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

Abstract

Background: Intrauterine myelomeningocele repair (IUMR) was first successfully performed in 1997. Preliminary reports suggest that this procedure reduces the incidence of shunt-dependent hydrocephalus when compared to conventional postnatal therapy. However, the existing cohort of IUMR patients has not yet been systematically compared to a comparable group of conventionally treated controls. Methods: Patients 1 year old or greater who had undergone IUMR at either Vanderbilt University or the Children’s Hospital of Philadelphia (CHOP) were compared to a group of conventionally treated historical controls treated and followed at CHOP. In order to measure any differences between the groups, patients were stratified according to the level of the myelomeningocele lesion and the gestational age at the time of IUMR. Results: One hundred and four IUMR patients were compared to 189 conventionally treated controls. IUMR resulted in statistically significant reductions in the incidence of shunt-dependent hydrocephalus at both lumbar and sacral lesion levels. When lumbar lesion levels were further stratified, from L1 to L5, it appeared that the benefit of IUMR was statistically significant only at levels below L2. Other factors with a significant impact on hydrocephalus were estimated gestational age and ventricular size at the time of surgery. In particular, statistically significant differences compared to controls were seen in the younger (≤25 weeks) group but not in the older (>25 weeks) group. Conclusions: IUMR appears to substantially reduce the incidence of shunt-dependent hydrocephalus when compared to conventional treatment even when lesion level is taken into account. Patients with lesions above L3 may not share in this benefit. IUMR cannot be justified in fetuses older than 25 weeks of gestation. Additional improvements might be obtained by further reducing the average age at which fetuses are operated upon. It remains to be determined whether this benefit outweighs the potential risks of intrauterine surgery.


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 6/6/2002
Accepted: 8/6/2002
Published online: 12/19/2002

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 6

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

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


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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
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 goverment 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.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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    External Resources

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  9. Sutton LN, Adzick NS, Bilaniuk LT, Johnson MP, Crombleholme TM, Flake AW: Improvement in hindbrain herniation demonstrated by serial fetal magnetic resonance imaging following fetal surgery for myelomeningocele. JAMA 1999;282:1826–1831.
  10. Bruner JP, Tulipan NB, Paschall RL, Boehm FH, Walsh WF, Silva SR, Henanz-Schulman M, Lowe LH, Reed GW: Fetal surgery for myelomeningocele and the incidence of shunt-dependent hydrocephalus. JAMA 1999;282:1819–1825.
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    External Resources

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