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Low level myelomeningoceles: do they need prenatal surgery?

  • Pierre-Aurelien Beuriat
  • Isabelle Poirot
  • Frederic Hameury
  • Delphine Demede
  • Kieron J. Sweeney
  • Alexandru Szathmari
  • Federico Di Rocco
  • Carmine MottoleseEmail author
Original Article
  • 33 Downloads

Abstract

Background

Postnatal closure of a myelomeningocele remains the standard of care in many countries. The prenatal closure has given hope for decreasing the damage to the neural placode and has challenged classic management. However, this technique presents potential sources of complications. Patients with MMC with an anatomical level of L4 and below have a better functional prognosis than higher level malformations. Are they still candidates for prenatal surgery?

Objective

To evaluate outcome of MMC with an anatomical level of L4 and below and discuss, with support of the literature, the indications to perform prenatal closure in this particular group of patients.

Materials and methods

Twenty-nine children were included in this observational study. The level of the vertebral malformation was sacral in 12 cases (41.4%) or lumbar (level ≤ L4) in 17 cases (58.6%). All the patients was operated postnatally for closure of the MMC with microsurgical technique as soon as possible after clinical evaluation (range 0–97 days).

Results

Only 11 out of 29 patients (37.9%) needed of a CSF diversion. A Chiari II malformation was present before MMC closure in 17 patients (58.6%) and only in 5 (17%) after. Twenty-six patients (89.7%) were able to walk. Seven (23%) and 16 (55%) of our patients have a normal bladder and bowel control, respectively. All school-aged children attend school.

Conclusions

The functional outcome for low-level MMC is good when managed with modern microneurosurgical techniques with a low risk for the patient and the mother. Therefore, we do not suggest prenatal surgery for subgroup of infant with MM.

Keywords

Spinal dysraphism Multidisciplinary management Pediatric Postnatal surgery Myelomeningocele Prenatal surgery 

Abbreviations

CM

centimeter

CM-II

Chiari type II malformation

CPC

Choroid plexus coagulation

CS

Cesarean-section

CSF

Cerebro spinal fluid

ETV

Endoscopic third ventriculostomy

GMF-CS

Gross motor function classification system

Gr

grams

MMC

Myelomeningocele

MOMS

Management of myelomeningocele study

MRI

Magnetic resonance imaging

US

scan ultra-sound scan

VP

Shunt ventriculo-peritoneal Shunt

WG

Week of gestation

Notes

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Pierre-Aurelien Beuriat
    • 1
  • Isabelle Poirot
    • 2
  • Frederic Hameury
    • 3
  • Delphine Demede
    • 3
  • Kieron J. Sweeney
    • 1
  • Alexandru Szathmari
    • 1
  • Federico Di Rocco
    • 1
  • Carmine Mottolese
    • 1
    Email author
  1. 1.Department of Pediatric NeurosurgeryHôpital Femme Mère EnfantLyon CedexFrance
  2. 2.Department of Pediatric Rehabilitation l’ESCALEHôpital Femme Mère EnfantLyon CedexFrance
  3. 3.Department of Urologic SurgeryHôpital Femme Mère EnfantLyon CedexFrance

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