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Child's Nervous System

, Volume 28, Issue 3, pp 461–467 | Cite as

Intrauterine myelomeningocele repair Postnatal results and follow-up at 3.5 years of age — initial experience from a single reference service in Brazil

  • Wagner Jou Hisaba
  • Sérgio Cavalheiro
  • Carlos Gilberto Almodim
  • Carolina Peixoto Borges
  • Tereza Cristina Carbonari de Faria
  • Edward Araujo JúniorEmail author
  • Luciano Marcondes Machado Nardozza
  • Antonio Fernandes Moron
Original Paper

Abstract

Purpose

Present the outcomes of six cases submitted to intrauterine myelomeningocele (MMC) repair.

Methods

Descriptive observational study of six children submitted to antenatal surgical repair of MMC between 26 and 27 weeks gestation. All deliveries were through cesarean section. The following neonatal variables were assessed: gestational age at delivery, birth weight, Apgar scores, need for intubation, duration of hospital stay and need for postnatal shunt procedures. After 3.5 years, the children were evaluated using the Columbia Mental Maturity Scale or Denver II tests and the Hoffer Ambulation Scale.

Results

All deliveries were preterm at a mean gestational age of 32 + 4 weeks and mean birth weight was 1,942 g. Two infants had Apgar scores <7 at 1 min and 1 at 5 min. Ventricular–peritoneal shunts were placed in two cases. All six children are alive: five have normal cognitive development and one has a neuropsychomotor developmental delay. Two children had normal leg movements, a sacral functional level and are community ambulators. Three children had upper lumbar anatomical level lesions and one had a lower thoracic level lesion at the time of fetal surgery. One child, with an L1–L2 anatomical level lesion, in noambulatory and fully dependent on a wheelchair for mobility.

Conclusion

Antenatal surgical repair of MMC reduced the need for postnatal shunt placements. Despite preterm delivery, the cognitive development of most children at 3.5 years was normal. Antenatal surgery seemed to improve lower limb motor function in these cases.

Keywords

Myelomeningocele Intrauterine surgery Postnatal results Cognitive results Motor results 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Wagner Jou Hisaba
    • 1
  • Sérgio Cavalheiro
    • 2
  • Carlos Gilberto Almodim
    • 1
  • Carolina Peixoto Borges
    • 1
  • Tereza Cristina Carbonari de Faria
    • 2
  • Edward Araujo Júnior
    • 1
    • 3
    Email author
  • Luciano Marcondes Machado Nardozza
    • 1
  • Antonio Fernandes Moron
    • 1
  1. 1.Department of ObstetricsFederal University of São Paulo (UNIFESP)São PauloBrazil
  2. 2.Department of NeurosurgeryFederal University of São Paulo (UNIFESP)São PauloBrazil
  3. 3.Department of ObstetricsFederal University of São Paulo (UNIFESP)São PauloBrazil

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