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Journal of Gynecology Obstetrics and... Sep 2023To investigate height of the corpus callosum (CC) in order to describe the corpus callosum anomalies in fetuses with meningomyelocele (MMC) and compare these findings...
PURPOSE
To investigate height of the corpus callosum (CC) in order to describe the corpus callosum anomalies in fetuses with meningomyelocele (MMC) and compare these findings with the corpus callosum of healthy fetuses.
METHODS
In this study, fetal MRI examinations were performed on 44 fetal MMC malformation cases. As the control group, 34 fetal MRI examinations, which were anatomically normal, were evaluated retrospectively. In the study group, lateral ventricle diameter, the level and diameter of the MMC defect, and CC height were measured. In the control group, CC height and lateral ventricular diameter were measured.
RESULTS
The mean CC body height was 1.36 mm in the study group, and 2.48 mm in the control group. The height of the CC body region of the study population was inclined to be thinner compared with the control population (p<0.001).
CONCLUSIONS
The fact that the height of the CC body region was found to be thinner in fetal MRI in cases of MMC compared with normal fetuses suggests that various callosal anomalies are uncertain, investigation of additional callosal anomalies may be beneficial in the decision for the continuation of pregnancy, and termination or intrauterine surgery in cases with MMC. Further large case group studies are needed.
Topics: Female; Pregnancy; Humans; Meningomyelocele; Corpus Callosum; Retrospective Studies; Fetus; Prenatal Care
PubMed: 37295771
DOI: 10.1016/j.jogoh.2023.102619 -
Use of radiographs, ultrasound and computed tomography for diagnosis of a meningomyelocele in a dog.The Journal of Small Animal Practice Aug 2020
Topics: Animals; Dog Diseases; Dogs; Meningomyelocele; Radiography; Tomography, X-Ray Computed; Ultrasonography
PubMed: 32692868
DOI: 10.1111/jsap.13191 -
Pediatric Nephrology (Berlin, Germany) Aug 2008The commonest cause of neurogenic bladder in children is myelomeningocele. Survival of children is much improved in the Western world, but by 35 years old, about 50%... (Review)
Review
The commonest cause of neurogenic bladder in children is myelomeningocele. Survival of children is much improved in the Western world, but by 35 years old, about 50% will have died. In adults, the commonest causes of death are lung and heart diseases. All physical aspects deteriorate with age, especially in those with thoracic lesions. Those who walk in childhood have a 20-50% chance of becoming wheelchair dependent as adults. Immobility, poor respiratory reserve, obesity, latex allergy and worsening kyphoscoliosis contribute to the increased risks of surgery. It is essential that safe and manageable urine drainage is established in childhood: the bladder never improves with time, and surgical reconstruction becomes progressively more difficult. Independence in adult life will only be possible with intense preparation in childhood. Children must be allowed to join in with family chores and events. Education, both academic and practical, must be encouraged. Skills such as driving, shopping and birth control must be taught. However, even with the best support, less than 40% will have gainful employment. Children who are continent and have lesions below L2 are likely to have normal sexual function. Sexual activity in adolescents, especially in those with hydrocephalus, is limited (but not absent). However, by adult life, about two thirds will have established a regular partnership. All females and those males who are naturally potent are likely to be fertile. There is a high risk of neural tube defects in their offspring unless the female partner takes prophylactic folic acid for 3 months before pregnancy and for first trimester.
Topics: Adaptation, Psychological; Child; Education, Medical, Continuing; Humans; Meningomyelocele; Quality of Life; Treatment Outcome; Urinary Bladder, Neurogenic
PubMed: 18200450
DOI: 10.1007/s00467-007-0663-3 -
Child's Nervous System : ChNS :... Nov 2023
Topics: Humans; Child; Spinal Puncture; Meningomyelocele
PubMed: 37542701
DOI: 10.1007/s00381-023-06116-7 -
Neurosurgical Focus Oct 2012Lipomyelomeningocele represents a rare but complex neurological disorder that may present with neurological deterioration secondary to an inherent tethered spinal cord.... (Review)
Review
Lipomyelomeningocele represents a rare but complex neurological disorder that may present with neurological deterioration secondary to an inherent tethered spinal cord. Radiological testing is beneficial in determining the morphology of the malformation. Specialized testing such as urodynamic studies and neurophysiological testing may be beneficial in assessing for neurological dysfunction secondary to the lipomyelomeningocele. Early surgical intervention may be beneficial in preventing further neurological decline.
Topics: Animals; Humans; Meningomyelocele; Neural Tube Defects; Treatment Outcome
PubMed: 23025444
DOI: 10.3171/2012.7.FOCUS12224 -
Journal of Neurosurgery. Pediatrics Mar 2012In a recently completed randomized, prospective clinical trial, fetal repair for myelomeningocele was shown to result in reduced rates of hydrocephalus requiring... (Review)
Review
In a recently completed randomized, prospective clinical trial, fetal repair for myelomeningocele was shown to result in reduced rates of hydrocephalus requiring placement of a ventriculoperitoneal shunt, improvement in Chiari malformation Type II, and improvement in neurological function compared with standard postnatal repair. Successful fetal surgery requires the active participation and interaction of several clinical teams. Each group has a specific role, and overlap is often required at different points of the treatment plan. Extensive multispecialty discussions with the patient and family are necessary before informed consent can be obtained. Fetal surgery carries significant risks to the mother and fetus and these must be carefully considered prior to a final treatment decision. This review will summarize the evaluation and treatment of patients undergoing fetal repair for myelomeningocele at one institution.
Topics: Female; Fetal Therapies; Fetus; Humans; Hysterotomy; Meningomyelocele; Pregnancy
PubMed: 22380954
DOI: 10.3171/2011.12.PEDS11403 -
Child's Nervous System : ChNS :... Oct 2023Myelomeningocele (MMC) is one of the representative anomalies in the field of pediatric neurosurgery. During the 50 years of ISPN history, MMC had a tremendous changes... (Review)
Review
PURPOSE
Myelomeningocele (MMC) is one of the representative anomalies in the field of pediatric neurosurgery. During the 50 years of ISPN history, MMC had a tremendous changes in its incidence, clinical management and outcome with advanced understanding of its pathogenesis. We reviewed the changes in MMC during the period.
METHODS
We reviewed the literature review and collected our experiences.
RESULTS
During the 50 years, major changes happened in many aspects of MMC including incidence, pathoembryogenesis, folate deficiency, prevention, prenatal diagnosis, mode of delivery, treatment policy with ethical considerations, clinical treatment including fetal surgery, latex allergy, retethering, management outcome, multidisciplinary team approach, and socioeconomic and family issues.
CONCLUSIONS
There was a great advance in the management and research of MMC during the 50 years. It is a monumental achievement of pediatric neurosurgeons and colleagues of the related fields.
Topics: Pregnancy; Female; Humans; Child; Meningomyelocele; Prenatal Diagnosis; Fetal Therapies; Neurosurgical Procedures; Neurosurgeons
PubMed: 37417984
DOI: 10.1007/s00381-023-06057-1 -
Gynecologie, Obstetrique, Fertilite &... Feb 2022Fetal myelomeningocele surgery was introduced in France in 2014. Developments in prenatal diagnosis of neural tube defects have accompanied the development of prenatal...
Fetal myelomeningocele surgery was introduced in France in 2014. Developments in prenatal diagnosis of neural tube defects have accompanied the development of prenatal diagnosis. This fetal surgery represents one of the three possible care paths for pregnant women faced with this prenatal diagnosis. The ethical issues of this fetal surgery are discussed and in particular regarding prenatal counselling and patient autonomy of choice.
Topics: Female; France; Humans; Meningomyelocele; Pregnancy; Prenatal Diagnosis
PubMed: 34656790
DOI: 10.1016/j.gofs.2021.10.006 -
Best Practice & Research. Clinical... Jul 2019The most common congenital defect of the central nervous system is myelomeningocele (MMC), which results in significant physical limitations for those affected.... (Review)
Review
The most common congenital defect of the central nervous system is myelomeningocele (MMC), which results in significant physical limitations for those affected. Neurologic injury associated with MMC begins with abnormal neurulation and is perpetuated by subsequent traumatic and toxic injury sustained in utero. Treatment historically has involved surgical closure of the MMC after birth along with neonatal management of the associated sequelae including cerebrospinal fluid diversion by ventricular shunting. With improvements in prenatal diagnosis, a defined antenatal natural history, and the concept of fetal intervention to arrest or reverse ongoing in utero damage, maternal-fetal surgery for MMC closure developed as a feasible therapy. Animal studies and early human studies investigating in utero MMC closure were promising, leading to Management of Myelomeningocele Study (MOMS trial). This prospective randomized multicenter trial comparing in utero fetal MMC (fMMC) closure to routine postnatal closure demonstrated a decreased need for shunting, reversal of hindbrain herniation, and improved neurologic function in the prenatal repair group, although maternal complications and prematurity were more frequently encountered. Because of the conclusion of the MOMS trial, fMMC closure has become a standard of care option for pregnancies complicated by a prenatal diagnosis of spina bifida. This article will provide background to the scope of MMC, review the MOMS trial data, and highlight the current clinical status of open fMMC closure.
Topics: Adult; Female; Fetal Therapies; Humans; Meningomyelocele; Pregnancy; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 31078425
DOI: 10.1016/j.bpobgyn.2019.03.004 -
Annals of Plastic Surgery Aug 2012Meningomyelocele is one of the most common congenital defects of the central nervous system. Reconstruction of these defects must be performed immediately after delivery...
Meningomyelocele is one of the most common congenital defects of the central nervous system. Reconstruction of these defects must be performed immediately after delivery to prevent complications such as primary meningitis and to protect the neural tissues. The most important factors in the surgical treatment of meningomyelocele defects are the size of the defect, its location, the presence of kyphosis, and the quality of the surrounding tissue. The chosen method must be a simple one that causes minimal blood loss, requires a short duration of surgery, and covers the surface of the neural defect with a soft-tissue mass enabling closure without tension. In our study, satisfactory results have been obtained using 1 or 2 fasciocutaneous flaps based on the midline in 20 patients with large meningomyelocele defects where primary closure was not possible. A single flap based superiorly on the midline was sufficient to close the defects in patients without kyphosis. In patients with concurrent kyphosis, a second flap based inferiorly on the midline has been used. All flaps survived, except for a distal partial necrosis observed in 1 patient. In the method we used, we adopted a defect reconstruction that is similar to the normal anatomic structures and resistant to trauma and infections, and does not sacrifice any muscle tissue. According to our clinical experiences, this method is useful for large meningomyelocele defects that are unsuitable for primary closure.
Topics: Female; Humans; Infant; Infant, Newborn; Kyphosis; Male; Meningomyelocele; Plastic Surgery Procedures; Surgical Flaps; Treatment Outcome
PubMed: 21734541
DOI: 10.1097/SAP.0b013e31822592c4