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Myelomeningocele

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https://www.readbyqxmd.com/read/28550526/fetoscopic-patch-coverage-of-experimental-myelomenigocele-using-a-two-port-access-in-fetal-sheep
#1
Lucie Guilbaud, Nathalie Roux, Stéphanie Friszer, Charles Garabedian, Ferdinand Dhombres, Bettina Bessières, Catherine Fallet-Bianco, Federico Di Rocco, Michel Zerah, Jean-Marie Jouannic
PURPOSE: This study aims to assess the feasibility and the effectiveness of a fetoscopic myelomeningocele (MMC) coverage using a sealed inert patch through a two-port access, in the sheep model. METHODS: Forty-four fetuses underwent surgical creation of a MMC defect at day 75 and were divided into four groups according to the MMC repair technique, performed at day 90. Group 1 remained untreated. Group 2 had an open surgery using suture of the defect. Groups 3 and 4 underwent defect coverage using a Gore®-polytetrafluoroethylene patch secured with surgical adhesive (Bioglue®), with an open approach (group 3) and a fetoscopic one (group 4)...
May 26, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28548634/predictors-of-permanent-disability-among-adults-with-spinal-dysraphism
#2
Matthew C Davis, Betsy D Hopson, Jeffrey P Blount, Rachel Carroll, Tracey S Wilson, Danielle K Powell, Amie B Jackson McLain, Brandon G Rocque
OBJECTIVE Predictors of permanent disability among individuals with spinal dysraphism are not well established. In this study, the authors examined potential risk factors for self-reported permanent disability among adults with spinal dysraphism. METHODS A total of 188 consecutive individuals undergoing follow-up in an adult spinal dysraphism clinic completed a standardized National Spina Bifida Patient Registry survey. Chi-square tests and logistic regression were used to assess bivariate relationships, while multivariate logistic regression was used to identify factors independently associated with self-identification as "permanently disabled...
May 26, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28547209/anesthesia-for-myelomeningocele-surgery-in-fetus
#3
Juan Carlos Devoto, Juan Luis Alcalde, Felipe Otayza, Waldo Sepulveda
BACKGROUND: Administering anesthesia for prenatal repair of myelomeningocele reveals several issues that are unique to this new form of treatment. This includes issues such as fetal well-being, surgical conditions and monitoring, among others. Exploring, analyzing, and understanding the different variables that are involved will help us reduce the high level of risk associated with this surgery. OBJECTIVE: This review provides a systematic approach to the issues that are faced by anesthesiologists during fetal surgery...
May 25, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28536839/maternal-fetal-surgery-for-myelomeningocele-some-thoughts-on-ethical-legal-and-psychological-issues-in-a-western-european-situation
#4
Frank Van Calenbergh, Luc Joyeux, Jan Deprest
BACKGROUND: The results of the Management of Myelomeningocele Study (MOMS) randomized controlled trial have demonstrated that maternal-fetal surgery (MFS) for myelomeningocele (MMC) compared to postnatal MMC repair has clear neurological benefits for the child at 12 and 30 months of age. Level I evidence nevertheless does not provide answers to many questions in this delicate field. Since the beginning of 2012, our fetal center has been offering MFS for spina bifida aperta (SBA) to patients from different European and non-European countries, in a societal context where termination of pregnancy is the option chosen by most patients when being informed of this diagnosis...
May 23, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28516217/prenatal-surgery-for-myelomeningocele-review-of-the-literature-and-future-directions
#5
Gregory G Heuer, Julie S Moldenhauer, N Scott Adzick
Open spina bifida or myelomeningocele (MMC) is one of the most common serious congenital malformations. Historically, this condition has been treated with closure of the MMC defect shortly after birth. The goal of postnatal closure is to cover the exposed spinal cord and prevent infection. However, postnatal surgery does not reverse or prevent the neurologic injury seen in MMC, reverse hindbrain herniation, or prevent hydrocephalus. The neurologic defects result from primary incomplete neurulation and secondary chronic prenatal damage to the exposed neural elements through mechanical and chemical trauma...
May 17, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28516216/the-role-of-intrauterine-magnetic-resonance-in-the-management-of-myelomenigocele
#6
Denise Trigubo, Mercedes Negri, Rosana Mabel Salvatico, Gustavo Leguizamón
OBJECTIVE: To assess the role of magnetic resonance imaging (MRI) in the management of myelomenigocele. BACKGROUND: Spinal dysraphism or neural tube defects (NTD) encompass a heterogeneous group of congenital spinal anomalies that result from the defective closure of the neural tube early in gestation. Myelomeningocele is the most common type of NTD that is compatible with life, with high survival rates but lifelong physical impairments. CONCLUSION: MRI is an important adjunct to ultrasound in assessing NTD, as it pertains to pre-surgical planning and perinatal management...
May 17, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28512689/long-term-results-of-fibular-achilles-tenodesis-westin-s-tenodesis-for-paralytic-pes-calcaneus-is-hypercorrection-avoidable-a-longitudinal-retrospective-study
#7
Helder Henzo Yamada, Patricia Maria Moraes de Barros Fucs
PURPOSE: The purpose of this study was to review all cases of patients submitted to Westin's tenodesis, who had calcaneus feet secondary to myelomeningocele sequel, in order to evaluate the anatomical change provided by surgery and also to verify, in a long-term follow-up, the inversion of the deformity depending on the patient's age. METHODS: In this longitudinal retrospective study, all medical records of patients with myelomeningocele sequelae submitted to Westin's tenodesis from 1993 to 2013 in a public university hospital were reviewed...
May 16, 2017: International Orthopaedics
https://www.readbyqxmd.com/read/28510071/surgical-techniques-for-open-fetal-repair-of-myelomeningocele
#8
Nalin Gupta
The current standard for fetal repair of myelomeningocele is an open exposure of the gravid uterus with control of the amniotic membranes, and then a multi-layer closure of the fetal defect. The nature of the surgical repair has evolved and requires a series of steps that take into account the delicate nature of the fetal tissues. The individual surgical steps are described including potential pitfalls.
May 16, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28510070/sonographic-detection-of-open-spina-bifida-in-the-first-trimester-review-of-the-literature
#9
César Meller, Horacio Aiello, Lucas Otaño
In the beginnings, sonographic diagnosis of open spina bifida (OSB) relied on the meticulous scanning of the fetal vertebrae for abnormalities but many defects were missed. After the mid-1980s, however, with the description of the intracranial findings in the second trimester (the "lemon sign" and the "banana sign"), the prenatal diagnosis of OSB was enhanced. In the last 2 decades, there has been widespread uptake of routine ultrasound examination in the first trimester of pregnancy with the purpose of the measurement of fetal crown-rump length to determine gestational age, to screen for trisomy 21 and other aneuploidies, mainly with the nuchal translucency, and for diagnosis of many major abnormalities...
May 16, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28503628/visceral-hyperalgesia-when-to-consider-gabapentin-use-in-neonates-case-study-and-review
#10
Joseph Asaro, Christine A Robinson, Philip T Levy
Visceral hyperalgesia refers to increased pain sensation in response to gastrointestinal sensory stimulus. In neonates with neurological impairments, gabapentin has been successfully used as a treatment for visceral hyperalgesia in neonates. The authors describe a preterm infant with myelomeningocele and persistent neuropathic pain that manifested as irritability, hypertonicity, poor weight gain, and feeding intolerance. After exclusion of other etiologies, the diagnosis of visceral hyperalgesia was suspected and the infant was treated with gabapentin...
January 2017: Child Neurol Open
https://www.readbyqxmd.com/read/28500367/evolution-of-posterior-fossa-and-brain-morphology-after-in-utero-repair-of-open-neural-tube-defects-assessed-by-mri
#11
Christin Rethmann, Ianina Scheer, Martin Meuli, Luca Mazzone, Ueli Moehrlen, Christian Johannes Kellenberger
OBJECTIVES: To describe characteristics of foetuses undergoing in utero repair of open neural tube defects (ONTD) and assess postoperative evolution of posterior fossa and brain morphology. METHODS: Analysis of pre- and postoperative foetal as well as neonatal MRI of 27 foetuses who underwent in utero repair of ONTD. Type and level of ONTD, hindbrain configuration, posterior fossa and liquor space dimensions, and detection of associated findings were compared between MRI studies and to age-matched controls...
May 12, 2017: European Radiology
https://www.readbyqxmd.com/read/28499796/the-antenatal-urinary-tract-dilation-classification-system-accurately-predicts-severity-of-kidney-and-urinary-tract-abnormalities
#12
C D W Kaspar, M Lo, T E Bunchman, N Xiao
BACKGROUND: Urinary tract dilation (UTD) is a commonly diagnosed prenatal condition; however, it is currently unknown which features lead to benign and resolving or pathologic abnormalities. A consensus UTD classification system (antenatal UTD classification, UTD-A) was created by Nguyen et al. in 2014 [1], but has not yet been validated. OBJECTIVE: To evaluate the ability of the UTD-A system to identify kidney and urinary tract (KUT) abnormalities, assess whether UTD-A can predict severity of KUT conditions, and perform a cost analysis of screening ultrasound (US)...
April 21, 2017: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28497181/new-directions-in-fetal-surgery-for-myelomeningocele
#13
Sandra K Kabagambe, Y Julia Chen, Melissa A Vanover, Payam Saadai, Diana L Farmer
The treatment of children with myelomeningocele (MMC) has improved over time, from supportive management to early postnatal closure to prenatal repair of the defect. The Management of Myelomeningocele Study (MOMS) showed that prenatal repair of MMC resulted in improved neurological outcomes compared to postnatal closure. Follow-up studies showed that prenatal repair was, as with any other fetal intervention, associated with higher rates of obstetrical complications. There was no significant difference in urological outcomes...
May 11, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28479801/management-and-outcome-of-infantile-hydrocephalus-in-a-tertiary-health-institution-in-nigeria
#14
Ayodeji Salman Yusuf, Habeeb Kayodele Omokanye, Nurudeen Abiola Adeleke, Rukeme Oluaseun Akanbi, Sikiru Olalekan Ajiboye, Hakeem Gbadebo Ibrahim
BACKGROUND: Hydrocephalus is a leading cause of disability among children worldwide. The outcome depends on morphology and whether insult is pre- or post-natal. There has been improvement in morbidity in developed countries due to improved surgical care. A paucity of trained personnel impacts negatively on care and outcome of infants with hydrocephalus in many low-income countries resulting poorer outcome. We conducted an audit of patients with hydrocephalus managed in our institution to determine common etiology and outcome...
April 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/28470694/a-comparison-of-three-methods-of-measuring-tibial-torsion-in-children-with-myelomeningocele-and-normally-developing-children
#15
Cassie N Borish, Nicole M Mueske, Tishya A L Wren
INTRODUCTION Abnormal tibial torsion is a common pediatric problem, and there are many existing measurement methods. The purpose of this study was to compare three methods of measuring tibial torsion for its evaluation: computed tomography, physical examination, and motion capture. MATERIALS AND METHODS Twenty healthy children and 20 children with myelomeningocele underwent measures of tibial torsion bilaterally. Measurements were compared using correlation and Bland-Altman plots of the difference between measurements...
May 3, 2017: Clinical Anatomy
https://www.readbyqxmd.com/read/28470384/first-60-fetal-in-utero-myelomeningocele-repairs-at-saint-louis-fetal-care-institute-in-the-post-moms-trial-era-hydrocephalus-treatment-outcomes-endoscopic-third-ventriculostomy-versus-ventriculo-peritoneal-shunt
#16
Samer K Elbabaa, Anne M Gildehaus, Matthew J Pierson, J Andrew Albers, Emanuel J Vlastos
INTRODUCTION: The published results of the Management of Myelomeningocele Study (MOMS) trial in 2011 showed improved outcomes (reduced need for shunting, decreased incidence of Chiari II malformation, and improved scores of mental development and motor function) in the fetal prenatal repair group compared to the postnatal group. Historically, endoscopic third ventriculostomy (ETV) remains as a controversial hydrocephalus treatment option with high failure rates in pediatric patients with a history of myelomeningocele (MMC)...
May 3, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28463829/prenatal-sacral-anomalies-leading-to-the-detection-of-associated-spinal-cord-malformations
#17
Baptiste Morel, Stéphanie Friszer, Jean-Marie Jouannic, Hubert Ducou Le Pointe, Eléonore Blondiaux, Catherine Garel
INTRODUCTION: Systematic analysis of the spine is recommended as part of the basic sonographic examination. The aim of our study is to assess the proportion of spinal cord anomalies diagnosed following detection of a sacral anomaly. MATERIAL AND METHODS: We analyzed retrospectively collected data in a prenatal tertiary center during a 9-year period. Patients were referred for second-line ultrasound in the context of diabetes mellitus or following detection of pelvic or lower spine anomalies...
May 3, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/28452655/scoliosis-in-myelomeningocele-epidemiology-management-and-functional-outcome
#18
Nishit Mummareddy, Michael C Dewan, Michael R Mercier, Robert P Naftel, John C Wellons, Christopher M Bonfield
OBJECTIVE The authors aimed to provide an updated and consolidated report on the epidemiology, management, and functional outcome of cases of myelomeningocele (MMC) in patients with scoliosis. METHODS A comprehensive literature search was performed using MEDLINE, Embase, Google Scholar, and the Cochrane Database of Systematic Reviews on cases of MMC in patients with scoliosis between 1980 and 2016. The initial search yielded 670 reports. After removing duplicates and applying inclusion criteria, we included 32 full-text original articles in this study...
April 28, 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/28433844/neurological-decline-in-an-elderly-with-repaired-myelomeningocele-complicated-with-lumbar-canal-stenosis-a-case-report
#19
Shingo Matsuda, Satoshi Yamaguchi, Yosuke Kajihara, Masaaki Takeda, Manish Kolakshyapati, Kaoru Kurisu
BACKGROUND: Tethered cord syndrome is a well-known complication after myelomeningocele (MMC) repair in childhood. However, late complications in adults with a repaired MMC are not well understood. In particular, the influence of a degenerative spinal deformity on a sustained tethered cord is still unclear. CASE DESCRIPTION: A 63-year-old man with a repaired MMC presented with a progressive gait disturbance and numbness in both lower limbs. Magnetic resonance images demonstrated that the tethered spinal cord was compressed by severe canal stenosis along the entire lumbar spine...
April 19, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28431215/early-treatment-improves-urodynamic-prognosis-in-neurogenic-voiding-dysfunction-20-years-of-experience
#20
Lucia M Costa Monteiro, Glaura O Cruz, Juliana M Fontes, Eliane T R C Vieira, Eloá N Santos, Grace F Araújo, Eloane G Ramos
OBJECTIVE: To evaluate the association between early treatment and urodynamic improvement in pediatric and adolescent patients with neurogenic bladder. METHODOLOGY: Retrospective longitudinal and observational study (between 1990 and 2013) including patients with neurogenic bladder and myelomeningocele treated based on urodynamic results. The authors evaluated the urodynamic follow-up (bladder compliance and maximum bladder capacity and pressure) considering the first urodynamic improvement in two years as the outcome variable and early referral as the exposure variable, using a descriptive and multivariate analysis with logistic regression model...
April 18, 2017: Jornal de Pediatria
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