Intrauterine closure of myelomeningocele: an update.
Preliminary evidence suggests that intrauterine myelomeningocele repair may benefit patients by reducing the both incidence of hydrocephalus and the severity of the Chiari malformation; however, this benefit remains unproved. Furthermore, the procedure entails substantial risks not associated with conventional therapy. A randomized controlled trial of intrauterine and conventional therapies is underway. This study should definitively establish the procedure related risks and benefits. Regardless of the outcome, it is clear that the risks of intrauterine intervention need to be reduced before myelomeningocele, or other congenital malformations, can be effectively treated prior to birth. To that end, studies are being conducted to assess the potential advantages of applying state-of-the-art endoscopic techniques to intrauterine therapy. If benefit can be proven and risks reduced, intrauterine myelomeningocele repair has the potential to become the preferred therapy for patients suffering from this debilitating disease.
Tulipan
Noel
N
Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN 37232-2519, USA. noel.tulipan@vanderbilt.edu
D000328:Adult; D000818:Animals; D002557:Cerebrospinal Fluid Shunts; D002585:Cesarean Section; D000075202:Contraindications; D005260:Female; D005332:Fetoscopy / Q000009:adverse effects; D005333:Fetus / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008591:Meningomyelocele / Q000000981:diagnostic imaging / Q000196:embryology / Q000601:surgery*; D023421:Models, Animal; D015337:Multicenter Studies as Topic; D018579:Patient Selection; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012371:Robotics; D012756:Sheep; D016216:Ultrasonography, Prenatal; D020535:Video-Assisted Surgery