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Myelomeningocele

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https://www.readbyqxmd.com/read/28301843/specialty-based-variation-in-applying-maternal-fetal-surgery-trial-evidence
#1
Ryan M Antiel, Alan W Flake, Mark P Johnson, Nahla Khalek, Natalie E Rintoul, John D Lantos, Farr A Curlin, Jon C Tilburt, Chris Feudtner
INTRODUCTION: The Management of Myelomeningocele Study (MOMS) compared prenatal with postnatal surgery for fetal myelomeningocele (MMC). We sought to understand how subspecialists interpreted the trial results and whether their practice has changed. MATERIALS AND METHODS: Cross-sectional, mailed survey of 1,200 randomly selected maternal-fetal medicine (MFM) physicians, neonatologists, and pediatric surgeons. RESULTS: Of 1,176 eligible physicians, 670 (57%) responded...
March 17, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/28293496/closure-of-a-large-thoracolumbar-myelomeningocele-using-a-modified-bilateral-keystone-flap
#2
Hytham Jamjoom, Hatem Alnoman, Yasser Almadani
The keystone flap, an emerging reconstructive option that can be used in many parts of the body, is gaining popularity among reconstructive surgeons. These reliable and versatile flaps can be used for large myelomeningocele closure. A modified bilateral keystone flap was used to achieve tension-free closure of a large thoracolumbar myelomeningocele associated with severe kyphosis in a newborn girl. The flap was modified by undermining in the subfascial plane in the medial aspect of the middle third. This undermining was performed to facilitate flap movement while preserving random musculocutaneous perforators captured within the island of tissues...
December 2016: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28285380/urological-outcomes-of-myelomeningocele-and-lipomeningocele
#3
REVIEW
Yvonne Y Chan, Samantha K Sandlin, Eric A Kurzrock
PURPOSE OF REVIEW: Spina bifida is caused by incomplete neural tube closure during the first trimester. This condition may lead to bowel and bladder dysfunction as well as truncal weakness and motor anomalies. Presentations vary between myelomeningoceles and lipomeningoceles and may result in different outcomes. This review seeks to explore our current understanding of the variations in outcomes between individuals with myelomeningocele and lipomeningocele. RECENT FINDINGS: Prenatal intervention has become a standard of care for prenatal diagnoses of myelomeningocele and has been shown to reduce shunt placement and improve motor skills...
May 2017: Current Urology Reports
https://www.readbyqxmd.com/read/28279990/hindbrain-herniation-in-chiari-ii-malformation-on-fetal-and-postnatal-mri
#4
U D Nagaraj, K S Bierbrauer, B Zhang, J L Peiro, B M Kline-Fath
BACKGROUND AND PURPOSE: As the practice of in utero repair of myelomeningoceles becomes more prevalent, knowledge of the expected MR imaging findings has become increasingly important. Our aim was to examine neuroimaging findings with a focus on hindbrain herniation and ventricular size in fetuses with open spinal dysraphism and to compare them with postnatal imaging features in groups undergoing prenatal-versus-postnatal repair. MATERIALS AND METHODS: Single-center retrospective analysis was performed on MRIs of fetuses with open spinal dysraphism from January 2004 through July 2015 with available postnatal imaging...
March 9, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28277363/fetoscopic-open-neural-tube-defect-repair-development-and-refinement-of-a-two-port-carbon-dioxide-insufflation-technique
#5
Michael A Belfort, William E Whitehead, Alireza A Shamshirsaz, Zhoobin H Bateni, Oluyinka O Olutoye, Olutoyin A Olutoye, David G Mann, Jimmy Espinoza, Erin Williams, Timothy C Lee, Sundeep G Keswani, Nancy Ayres, Christopher I Cassady, Amy R Mehollin-Ray, Magdalena Sanz Cortes, Elena Carreras, Jose L Peiro, Rodrigo Ruano, Darrell L Cass
OBJECTIVE: To describe development of a two-port fetoscopic technique for spina bifida repair in the exteriorized, carbon dioxide-filled uterus and report early results of two cohorts of patients: the first 15 treated with an iterative technique and the latter 13 with a standardized technique. METHODS: This was a retrospective cohort study (2014-2016). All patients met Management of Myelomeningocele Study selection criteria. The intraoperative approach was iterative in the first 15 patients and was then standardized...
March 6, 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28262538/bladder-perforation-after-augmentation-cystoplasty-determining-the-best-management-option
#6
Ted Lee, David J Kozminski, David A Bloom, Julian Wan, John M Park
INTRODUCTION: Delayed bladder perforation is a well-described complication after augmentation cystoplasty. Although the frequency, risk factors, and diagnostic challenges are well documented, discussions regarding management strategies are sparse. OBJECTIVE: We evaluated our experience of managing augmented bladder perforation to interrogate the hypothesis that non-operative management can be used effectively. STUDY DESIGN: We retrospectively evaluated the management of 10 patients with augmented bladder perforations over a 16-year period (Jan 2000-Jan 2016)...
February 10, 2017: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28254445/new-device-for-intermittent-emptying-of-the-bladder-in-female-children-and-adolescents-a-pilot-study
#7
Salvador V C Lima, Fábio O Vilar, Eugênio S Lustosa, Daniel C C Aragão, Fernanda C F S Calisto, Flávia C M Pinto
INTRODUCTION: Urinary incontinence (UI) is a challenging problem for the urological community. Clean intermittent catheterization (CIC) is the most commonly used method to restore bladder emptying to the state close to the physiological condition. This procedure can cause negative aspects such as pain and possible urethral injury. In addition, there is a negative impact on self-image and decline in quality of patient's life. The aim of the present study was to evaluate the safety and efficacy of a new intraurethral self-retaining device (ISRD), in female children and adolescents, as an attractive alternative to CIC...
February 16, 2017: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28247115/pregnancy-and-delivery-after-myelomeningocele-repair-ventriculoperitoneal-shunt-implantation-and-augmentation-cystoplasty
#8
Masahiro Kameda, Etsuko Takahara, Motomu Kobayashi, Katsumi Sasaki, Ryuta Morihara, Isao Date
INTRODUCTION: Management of pregnancy and delivery of a patient with a history of myelomeningocele requires a multidisciplinary team approach. CASE REPORT: We report a case of pregnancy and delivery by a patient who had a history of myelomeningocele surgical repair, ventriculoperitoneal (VP) shunt, and bladder augmentation enterocystoplasty. Regarding types of delivery style, anesthesiologists recommended a Cesarean section under general anesthesia. However, urologists recommended a vaginal delivery because they were concerned that she would require a nephrostomy because of severe adhesion between her uterus and the neobladder if she had a Cesarean section...
February 28, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28219061/establishing-prenatal-surgery-for-myelomeningocele-in-asia-the-singapore-consensus
#9
Tuangsit Wataganara, Suresh Seshadri, Tak Yeung Leung, Citra Matter, Monawat Ngerncham, Namtip Triyasunant, Padmakar Vidyadhar Mali, Agnhitori Biswas, Katika Nawapun, Nisarat Phithakwatchara, Alan W Flake, Mark P Johnson, Arijit Biswas, Mahesh Choolani
OBJECTIVES: The Management of Myelomeningocele Study (MOMS Trial) has inspired many fetal therapy centers (FTCs) to offer open fetal surgery for myelomeningocele (MMC). This is an initial effort to create a candidate model that can be applicable to many parts of Asia. MATERIAL AND METHODS: A limited selection of specialists from 4 established FTCs in Thailand, Hong Kong, India, and Singapore met for a round table discussion. Experts from Children's Hospital of Philadelphia (CHOP) involved in the Trial moderated the session...
February 21, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/28215830/initial-urological-evaluation-and-management-of-children-with-neurogenic-bladder-due-to-myelomeningocele
#10
Cristian Sager, Carol Burek, Juan Pablo Corbetta, Santiago Weller, Javier Ruiz, Ramiro Perea, Enrique Lago, Yesica Gomez, Victor Durán, Juan Carlos López
INTRODUCTION: The proactive management of children with myelomeningocele (MMC) has contributed to decreasing their progression to end-stage renal disease, thanks to early urological evaluation and timing implementation of treatments. OBJECTIVE: To demonstrate that early urological evaluation of the urinary tract in MMC shows functional alterations in most cases, and that it requires medical intervention, even when in some cases the complementary imaging studies do not show any abnormalities...
January 30, 2017: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28206781/cognitive-control-and-associated-neural-correlates-in-adults-with-spina-bifida-myelomeningocele
#11
Ashley L Ware, Paulina A Kulesz, Jenifer Juranek, Paul T Cirino, Jack M Fletcher
OBJECTIVE: Accelerated aging can occur in adult survivors of neurodevelopmental disorders, but has been narrowly studied in spina bifida myelomeningocele (SBM). Since discrete aspects of cognitive control and related neural network macrostructure deteriorate in normal aging, the specificity and trajectory of cognition and neuropathology incurred across adulthood in SBM were examined. METHOD: Adults (N = 120) with and without SBM completed working memory span and manipulation tasks, and an inhibitory control task...
February 16, 2017: Neuropsychology
https://www.readbyqxmd.com/read/28198945/rehabilitation-of-children-and-adolescents-with-myelomeningocele-the-daily-life-of-mothers-caregiversrehabilitation-of-children-and-adolescents-with-myelomeningocele-the-daily-life-of-mothers-caregivers
#12
Giselle Lima de Freitas, Roseni Rosângela de Sena, Josana Cristina Faleiros E Silva, Fabiana Faleiros Santana Castro
Objective: To analyze the daily routine of mothers-caregivers of children and adolescents with myelomeningocele at home. Method: Descriptive, exploratory, qualitative research. Data were collected with 16 mothers of children and adolescents with myelomeningocele by means of interviews and observation from May to August 2015, in municipalities of Minas Gerais, Brazil. The data were submitted to qualitative analysis. Results: The daily care routine of the mothers at home revealed two empirical categories: a) the impact of the birth on naturalization of care, and (b) changes in the routine of the mothers and women...
February 9, 2017: Revista Gaúcha de Enfermagem
https://www.readbyqxmd.com/read/28196729/delayed-expansion-of-an-intracranial-cyst-induced-by-ventriculoperitoneal-shunt-in-a-patient-with-chiari-malformation-type-2
#13
Yoshinori Maki, Tsuyoshi Ohta, Hirokazu Onishi, Naoki Fukui, Masanori Morimoto
A male neonate was referred to our hospital for the treatment of myelomeningocele and hydrocephalus related to Chiari malformation type 2. After the placement of ventriculoperitoneal (VP) shunt for hydrocephalus, an intracranial cyst, which was asymptomatic at first, expanded and caused clinical symptoms due to increased intracranial pressure. The expansion of the cyst was confirmed dominantly in the right lateral ventricle where the VP shunt was inserted. Intraoperative findings through a neuroendoscope suggested that the expanded cyst was an isolated lesion...
February 11, 2017: Brain & Development
https://www.readbyqxmd.com/read/28186476/risk-factors-for-surgical-site-infection-following-nonshunt-pediatric-neurosurgery-a-review-of-9296-procedures-from-a-national-database-and-comparison-with-a-single-center-experience
#14
Brandon A Sherrod, Anastasia A Arynchyna, James M Johnston, Curtis J Rozzelle, Jeffrey P Blount, W Jerry Oakes, Brandon G Rocque
OBJECTIVE Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional data set specifically for better understanding SSI. METHODS The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) database for the years 2012-2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations...
February 10, 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/28186474/morbidity-associated-with-30-day-surgical-site-infection-following-nonshunt-pediatric-neurosurgery
#15
Brandon A Sherrod, Brandon G Rocque
OBJECTIVE Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. METHODS The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) 2012-2014 database, including all neurosurgical procedures performed on pediatric patients...
February 10, 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/28174536/exploring-the-pharmacokinetic-profile-of-remifentanil-in-mid-trimester-gestations-undergoing-fetal-intervention-procedures
#16
Judith A Smith, Roopali V Donepudi, Pedro S Argoti, Anita L Giezentanner, Ranu Jain, Noemi Boring, Elisa Garcia, Kenneth J Moise
Background: Indications for surgery during pregnancy have increased. Specifically fetal interventions have increased from conditions that were considered lethal like twin-twin transfusion syndrome and severe fetal anemia to non-lethal conditions like myelomeningocele. The optimal anesthetic agent for in utero surgery is yet to be determined. Success of the procedure is often dictated by the efficacy of the anesthetic to immobilize the fetus without over-sedating mom. Remifentanil is used as preferred agent due to its short half-life however pharmacokinetics in pregnancy is unknown...
2017: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/28157255/current-views-on-fetal-surgical-treatment-of-myelomeningocele-the-management-of-myelomeningocele-study-moms-trial-and-polish-clinical-experience
#17
Jacek Zamłyński, Ewa Horzelska, Mateusz Zamłyński, Katarzyna Olszak-Wąsik, Leszek Nowak, Piotr Bodzek, Tomasz Horzelski, Rafał Bablok, Anita Olejek
Myelomeningocele (MMC) is the most frequent congenital defect of the central nervous system for which there is no satisfactory alternative to postnatal treatment. On the contrary prenatal MMC surgery is conducting before birth and is aimed at protecting from Chiari II malformation. The main goal of fetal MMC repair is to improve development and life quality of children with Chiari II malformation. Management of Myelomeningocele Study (MOMS) which was published in 2011 clearly confirmed effectiveness of prenatal surgery...
2017: Ginekologia Polska
https://www.readbyqxmd.com/read/28120066/myelomeningocele-repair-surgical-management-based-on-a-30-year-experience
#18
Pier Paolo Mattogno, Luca Massimi, Giampiero Tamburrini, Paolo Frassanito, Concezio Di Rocco, Massimo Caldarelli
BACKGROUND: Myelomeningocele (MMC) is a rare but severe spinal defect resulting from a failed neurulation process. Surgical repair is a delicate procedure that needs accurate neuroanatomical knowledge and adequate surgical planning. MATERIALS AND METHODS: The authors report on the main problems of the surgical management of this type of dysraphism. The technique used for reconstruction, and the management strategies, are analyzed according to the authors' experience with more than 600 cases, in comparison with the relevant literature...
2017: Acta Neurochirurgica. Supplement
https://www.readbyqxmd.com/read/28116279/bilateral-femoral-fracture-in-a-newborn-with-myelomeningocele-at-cesarean-section-a-case-report
#19
Yusuf Erdem, Serkan Akpancar, M Hanifi Gemci
INTRODUCTION: Femur fractures as a result of birth trauma can still occur during the C/S, in spite of recent developments of surgical and anesthetic techniques. In this study, we aimed to present a rare case of a newborn with myelomeningocele who delivered by cesarean section due to breech presentation and sustained bilateral fracture of femoral shaft. CASE PRESENTATION: A 2690 g female newborn with myelomeningocele sustained bilateral femoral shaft fractures during cesarean section...
July 2016: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/28108023/the-intersection-of-fetal-palliative-care-and-fetal-surgery-addressing-mortality-and-quality-of-life
#20
David Munson
Over the last few decades, the fields of fetal surgery and maternal-fetal medicine have developed interventions aimed at modifying severe diseases in utero. Innovations in fetal approaches to congenital diaphragmatic hernia and myelomeningocele have shown considerable promise in modifying the clinical course with fetal intervention. Patients who present to fetal centers to be evaluated for these interventions face challenging decisions that directly relate to questions of mortality and quality of life. This article explores how clinicians might apply the tools and principles of fetal palliative care to supporting a woman and her family who are considering fetal surgery...
January 17, 2017: Seminars in Perinatology
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