Late gestational intrauterine myelomeningocele repair does not improve lower extremity function.
OBJECTIVE
To determine whether intrauterine myelomeningocele repair performed at between 20 and 28 weeks gestation improves lower extremity function (LEF).


METHODS
Thirty-seven consecutive patients who had undergone intrauterine repair of their myelomeningocele at Vanderbilt University Medical Center had their lower extremity function and radiographic level (first defective vertebral level) compared to these same parameters in 40 controls who had undergone traditional postgestational repair of their myelomeningocele at the Children's Hospital in Birmingham, Ala., USA.


RESULTS
Of all 77 patients (controls and study group), 13 had a LEF that matched their radiographic level, 27 had a LEF that was rostral to their radiographic level, and 37 had a LEF that was caudal to their radiographic level. Further stratification revealed that for the intrauterine repaired myelomeningoceles, 11% had no difference between LEF and radiographic level, 43% had a LEF that was rostral to their radiographic level, and 46% had a LEF that was caudal to their radiographic level. For those closed in a traditional manner, LEF matched their radiographic level, was rostral to their radiographic level, and was caudal to their radiographic level in 22.5%, 27.5%, and 50% respectively. However, the overall mean differences between institutions produced a p-value of 0.2026 (paired t-test).


CONCLUSIONS
Although the current timing of intrauterine myelomeningocele repair has been found to lessen the degree of herniation of the rhombencephalon and reduce the incidence of shunt-dependent hydrocephalus, it does not statistically improve LEF. Parents should be advised of these findings prior to surgical intervention so as to focus their expectations.
Tubbs
R Shane
RS
Department of Cell Biology, University of Alabama at Birmingham, USA. richard.tubbs@ccc.uab.edu
Chambers
M Renee
MR
Smyth
Matthew D
MD
Bartolucci
Alfred A
AA
Bruner
Joseph P
JP
Tulipan
Noel
N
Oakes
W Jerry
WJ
D005260:Female; D005315:Fetal Diseases / Q000503:physiopathology / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007866:Leg / Q000503:physiopathology*; D008591:Meningomyelocele / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D010264:Paraplegia / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D018743:Perinatal Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D011596:Psychomotor Disorders / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014599:Uterus / Q000503:physiopathology / Q000601:surgery*