Assessment of neurosurgical outcome in children prenatally diagnosed with myelomeningocele and development of a protocol for fetal surgery to prevent hydrocephalus.
BACKGROUND
Prenatal diagnosis of myelomeningocele (MMC) has permitted a better planning for optimum management of the disease. More recently, it has allowed for a possible intrauterine repair of the spinal defect.


OBJECTIVE
To describe neurosurgical outcome in children with myelomeningocele and follow-up at a referral center in Fetal Medicine. Patients were characterized for the development of a protocol suitable for fetal surgery, and fetuses who were possible candidates for intrauterine surgery were identified.


METHODS
A retrospective descriptive analysis was performed of 98 cases of fetal myelomeningocele, seen at CAISM-UNICAMP, from January 1994 to December 2002, identifying cases with a possible indication for fetal surgery.


RESULTS
Mean gestational age at diagnosis was 29 weeks (17-39); level of lesion was above the sacral region in 92.84%; association with hydrocephalus occurred in 78.57%. During clinical course, 82.5% of patients had neurogenic bladder and 60% had neural and mental deficits. Potential intrauterine repair rate was 11.57%, using criteria from the protocol developed in our service.


CONCLUSIONS
Myelomeningocele is associated with severe and frequent sequelae. In virtually 12% of our cases, fetal surgery could have been offered as a therapeutic option.
Zambelli
Helder
H
Discipline of Neurosurgery-Fetal Medicine Group, Universidade Estadual de Campinas-UNICAMP, Rua Alexander Fleming, 181, Barão Geraldo, Campinas-SP, Brazil. hzambelli@uol.com.br
Carelli
Edmur
E
Honorato
Donizeti
D
Marba
Sérgio
S
Coelho
Giselle
G
Carnevalle
Aline
A
Iscaife
Alexandre
A
da Silva
Elton
E
Barini
Ricardo
R
Sbragia
Lourenço
L
D000328:Adult; D005260:Female; D005315:Fetal Diseases / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008591:Meningomyelocele / Q000601:surgery*; D009493:Neurosurgery; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome