title: Does a myelomeningocele sac compared to no sac result in decreased postnatal leg function following maternal fetal surgery for spina bifida aperta?
abstract: OBJECTIVE
  A fetus with large sac S1 myelomeningocele (MMC) but bilateral talipes prompted the question, 'Does the presence or size of an MMC sac affect postnatal leg function?'
  
  
  METHODS
  An MMC database with prenatal, birth, and a minimum of 1-year follow-up evaluation was reviewed. All fetuses had in-utero MMC repair at 20 + 0 to 25 + 6 weeks at a single institution. Fifty-four fetuses had prenatal evaluation, with 48 children completing a birth and a 1-year evaluation of leg function.
  
  
  RESULTS
  An MMC sac was present in 38/54 (70%) of fetuses evaluated in-utero and had been present in 35/48 (73%) of children evaluated at 1 year of age. Although leg function evaluated at 1 year was better than expected in the 'no sac' group (p = 0.059), this did not reach statistical significance.
  
  
  CONCLUSIONS
  The presence of an MMC sac may increase postnatal lower limb morbidity.
authors.affiliation: Department of Surgery and Obstetrics and Gynecology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4399, USA. wilsonrd@email.chop.edu
authors.forename: R Douglas
authors.initials: RD
authors.lastname: Wilson
authors.forename: Mark P
authors.initials: MP
authors.lastname: Johnson
authors.forename: Michael
authors.initials: M
authors.lastname: Bebbington
authors.forename: Alan W
authors.initials: AW
authors.lastname: Flake
authors.forename: Holly L
authors.initials: HL
authors.lastname: Hedrick
authors.forename: Leslie N
authors.initials: LN
authors.lastname: Sutton
authors.forename: N Scott
authors.initials: NS
authors.lastname: Adzick
mesh_terms: D015331:Cohort Studies; D005260:Female; D046128:Fetal Therapies / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000503:physiopathology; D007866:Leg / Q000473:pathology / Q000502:physiology*; D008591:Meningomyelocele / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D016137:Spina Bifida Cystica / Q000150:complications / Q000175:diagnosis / Q000601:surgery*