Skip to main content

Advertisement

SpringerLink
Log in

Successful developmental outcome in intrauterine myelomeningocele repair

  • Case Report
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Introduction

Myelomeningocele (MM) is one of the forms of dysraphism. Hydrocephalus secondary to Arnold-Chiari (AC) malformation is responsible for the morbidity and mortality of the disease. The intrauterine repair of MM may reverse AC and limit hydrocephalus progression.

Objective

The aim of this work is to report the successful outcome of a case of intrauterine correction of MM, with favorable evolution and birth at 36 weeks of pregnancy.

Case report

KCMC, 19 years old, was submitted to intrauterine repair of MM at 24 weeks of gestational age after approval by the family and the Research Ethics Committee of the School of Medical Sciences-UNICAMP.

Conclusion

Although it is not the standard option for surgical correction, selected MM cases with early fetal diagnosis may be eligible for intrauterine repair, when there is consensus with the Research Ethics Committees and family members.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bruner JP, Tulipan N, Paschall RL et al (1999) Fetal surgery for myelomeningocele and the incidence of shunt-dependent hydrocephalus. JAMA 282:1819–1825

    Article  PubMed  CAS  Google Scholar 

  2. Bruner JP, Tulipan NE, Richards WO (1997) Endoscopic coverage of fetal open myelomeningocele in utero. Am J Obste Gynecol 176:256–257

    Article  CAS  Google Scholar 

  3. Centers for Disease Control (1989) Economic burden of spina bifida—United States, 1980–1990. MMWR CDC Surveill Summ 38:264–267

    Google Scholar 

  4. Dillon CM, Davis BE, Duguay S et al (2000) Longevity of patients born with myelomeningocele. Eur J Pediatr Surg 10(Suppl 1):33–34

    Article  PubMed  Google Scholar 

  5. Heffez DS, Aryanpur J, Hutchins GM, Freeman JM (1990) The paralysis associated with myelomeningocele: clinical and experimental data implicating a preventable cord injury. Neurosurgery 26:987–992

    Article  PubMed  CAS  Google Scholar 

  6. Lary JM, Edmonds LD (1996) Prevalence of spina bifida at birth—United States, 1983–1990: a comparison of two surveillance systems. MMWR CDC Surveill Summ 45:15–26

    PubMed  CAS  Google Scholar 

  7. Meuli M, Meuli-Simmen C, Hutchins GM, Yingling CD, Hoffman KM, Harrison MR et al (1995) In utero surgery rescues neurologic function at birth in sheep with spina bifida. Nat Med 1:342–347

    Article  PubMed  CAS  Google Scholar 

  8. Michejda M (1984) Intrauterine treatment of spina bifida: Primate model. Z Kinderchir 39:259–261

    PubMed  CAS  Google Scholar 

  9. Osaka K, Tanimura T, Hirayama A, Matsumoto S (1978) Myelomeningocele before birth. J Neurosurg 49:711–724

    Article  PubMed  CAS  Google Scholar 

  10. Paek BW, Farmer DL, Wilkinson CC, Albanese CT, Peacock W, Harrison MR, Jennings RW (2000) Hindbrain herniation develops in surgically created myelomeningocele but is absent after repair in fetal lambs. Am J Obstet Gynecol 183(5):1119–1123

    Article  PubMed  CAS  Google Scholar 

  11. Reigel DH (1982) Spina bifida. In: Pediatric neurosurgery, Surgery of the developing nervous system. Section of Pediatric Neurosurgery of the American Association of Neurological Surgeons. Grune & Stratton, New York, pp 23–47 (chapter 2)

    Google Scholar 

  12. Rintoul N, Sutton LN, Hubbard AM, Cohen B, Melchioni J, Pasquariello PS et al (2002) A new look at myelomeningocele: functional level, vertebral level, shunting and implications for fetal intervention. Pediatrics 109:409–413

    Article  PubMed  Google Scholar 

  13. Stark GD, Drummond M (1971) The spinal cord lesion in myelomeningocele. Dev Med Child Neurol 13(Suppl 25):1–14

    Google Scholar 

  14. Stark GD, Baker GCW (1967) The neurological involvement of the lower limbs in meningomyelocele. Dev Med Child Neurol 9:732–744

    Article  Google Scholar 

  15. Tubbs RS, Chambers MR, Smyth MD, Bartolucci AA, Bruner JP, Tulipan N, Oakes WJ (2003) Late gestational intrauterine myelomeningocele repair does not improve lower extremity function. Pediatr Neurosurg 38:128–132

    Article  PubMed  Google Scholar 

  16. Tulipan N, Bruner JP (1998) Myelomeningocele repair in utero: a report of three cases. Pediatr Neurosurg 28:177–180

    Article  PubMed  CAS  Google Scholar 

  17. Urich H (1976) Malformations of the nervous system, perinatal damage and related conditions in early life. In: Blackwood W, Corsellis JAN (eds) Greenfield’s neuropathology. Edward Arnold Ltd, London, pp 361–469

    Google Scholar 

  18. Walsh DS, Adzick NS, Sutton LN, Johnson MP (2001) The rationale for in utero repair of myelomeningocele. Fetal Diagn Ther 16:312–322

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

We would like to acknowledge Ms. Sherian Kae Bowyer for giving us assistance in writing this paper in English.

Author information

Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Department of Neurology, State University of Campinas, UNICAMP, Campinas, Sao Paulo, Brazil

    Helder Zambelli

  2. Department of Obstetrics and Gynecology, State University of Campinas, UNICAMP, Campinas, Sao Paulo, Brazil

    Ricardo Barini & Kleber Cursino

  3. Division of Pediatric Surgery and Maternal Fetal Medicine, Department of Surgery, Faculdade de Ciências Médicas, Universidade Estadual de Campinas—UNICAMP, Rua Alexander Fleming, 181, Barão Geraldo, Campinas, Sao Paulo, 13084-970, Brazil

    Alexandre Iscaife & Lourenço Sbragia

  4. Department of Anesthesiology, State University of Campinas, UNICAMP, Campinas, Sao Paulo, Brazil

    Angélica de Fátima A. Braga

  5. Division of Neonatology, Department of Pediatrics, State University of Campinas, UNICAMP, Campinas, Sao Paulo, Brazil

    Sérgio Marba

Authors
  1. Helder Zambelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ricardo Barini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexandre Iscaife
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kleber Cursino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angélica de Fátima A. Braga
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sérgio Marba
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lourenço Sbragia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lourenço Sbragia.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zambelli, H., Barini, R., Iscaife, A. et al. Successful developmental outcome in intrauterine myelomeningocele repair. Childs Nerv Syst 23, 123–126 (2007). https://doi.org/10.1007/s00381-006-0169-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-006-0169-5

Keywords

Search

Navigation