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Assessment of neurosurgical outcome in children prenatally diagnosed with myelomeningocele and development of a protocol for fetal surgery to prevent hydrocephalus

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Abstract

Introduction

Prenatal diagnosis of myelomeningocele (MMC) has permitted a better planning for optimum management of the disease. More recently, it has allowed for a possible intrauterine repair of the spinal defect.

Objective

To describe neurosurgical outcome in children with myelomeningocele and follow-up at a referral center in Fetal Medicine. Patients were characterized for the development of a protocol suitable for fetal surgery, and fetuses who were possible candidates for intrauterine surgery were identified.

Materials and methods

A retrospective descriptive analysis was performed of 98 cases of fetal myelomeningocele, seen at CAISM-UNICAMP, from January 1994 to December 2002, identifying cases with a possible indication for fetal surgery.

Results

Mean gestational age at diagnosis was 29 weeks (17–39); level of lesion was above the sacral region in 92.84%; association with hydrocephalus occurred in 78.57%. During clinical course, 82.5% of patients had neurogenic bladder and 60% had neural and mental deficits. Potential intrauterine repair rate was 11.57%, using criteria from the protocol developed in our service.

Conclusion

Myelomeningocele is associated with severe and frequent sequelae. In virtually 12% of our cases, fetal surgery could have been offered as a therapeutic option.

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Authors and Affiliations

  1. Discipline of Neurosurgery—Fetal Medicine Group, Universidade Estadual de Campinas-UNICAMP, Rua Alexander Fleming, 181, Barão Geraldo, 13084-970, Campinas-SP, Brazil

    Helder Zambelli, Edmur Carelli, Donizeti Honorato, Giselle Coelho, Aline Carnevalle & Elton da Silva

  2. Division of Neonatology—Department of Pediatrics, Universidade Estadual de Campinas-UNICAMP, Rua Alexander Fleming, 181, Barão Geraldo, 13084-970, Campinas-SP, Brazil

    Sérgio Marba

  3. Division of Pediatric Surgery—Department of Surgery, Universidade Estadual de Campinas-UNICAMP, Rua Alexander Fleming, 181, Barão Geraldo, 13084-970, Campinas-SP, Brazil

    Alexandre Iscaife & Lourenço Sbragia

  4. Department of Obstetrics and Gynecology, Universidade Estadual de Campinas-UNICAMP, Rua Alexander Fleming, 181, Barão Geraldo, 13084-970, Campinas-SP, Brazil

    Ricardo Barini

  5. Division of Pediatric Surgery and Division of Maternal Fetal Medicine, School of Medicine, Universidade Estadual de Campinas-UNICAMP, Rua Alexander Fleming, 181, Barão Geraldo, 13084-970, Campinas-SP, Brazil

    Helder Zambelli & Lourenço Sbragia

Authors
  1. Helder Zambelli
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  2. Edmur Carelli
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  3. Donizeti Honorato
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  4. Sérgio Marba
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  5. Giselle Coelho
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  6. Aline Carnevalle
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  7. Alexandre Iscaife
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  8. Elton da Silva
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  9. Ricardo Barini
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  10. Lourenço Sbragia
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Corresponding authors

Correspondence to Helder Zambelli or Lourenço Sbragia.

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Zambelli, H., Carelli, E., Honorato, D. et al. Assessment of neurosurgical outcome in children prenatally diagnosed with myelomeningocele and development of a protocol for fetal surgery to prevent hydrocephalus. Childs Nerv Syst 23, 421–425 (2007). https://doi.org/10.1007/s00381-006-0261-x

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  • DOI: https://doi.org/10.1007/s00381-006-0261-x

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