Fetal myelomeningocele repair: short-term clinical outcomes.
OBJECTIVE
The study was undertaken to evaluate short-term clinical outcomes with antenatal myelomeningocele (MMC) repair.


METHODS
Retrospective review of 50 fetuses that underwent open fetal MMC closure was performed. Inclusion criteria included less than 26 weeks' gestation, thoracic to S1 level defect, absent clubfoot deformity, Arnold-Chiari malformation, ventriculomegaly less than 17 mm, normal karyotype, and no other anomalies.


RESULTS
Perinatal survival was 94% (47/50 fetuses). Mean age at delivery was 34 weeks 3 days. All fetuses demonstrated reversal of hindbrain herniation. Forty-three percent of the 50 fetuses have required ventriculoperitoneal shunting compared with 100% thoracic, 88% lumbar, and 68% sacral (85% overall) in 297 historic controls. Better-than-predicted leg function was seen in 57% of thoracic and lumbar level lesion patients.


CONCLUSIONS
Early experience with fetal MMC repair suggests a decreased need for ventriculoperitoneal shunting, arrest or slowing of progressive ventriculomegaly, and consistent resolution of hindbrain herniation. However, further long-term follow-up is needed to evaluate neurodevelopment and bladder and bowel function.
Johnson
Mark P
MP
Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadephia, PA 19104, USA. johnsonma@email.chop.edu
Sutton
Leslie N
LN
Rintoul
Natalie
N
Crombleholme
Timothy M
TM
Flake
Alan W
AW
Howell
Lori J
LJ
Hedrick
Holly L
HL
Wilson
R Douglas
RD
Adzick
N Scott
NS
D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D005315:Fetal Diseases / Q000503:physiopathology / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007866:Leg / Q000503:physiopathology; D008161:Lumbosacral Region; D008591:Meningomyelocele / Q000196:embryology* / Q000503:physiopathology / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D013909:Thorax; D013997:Time Factors; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt