Does a myelomeningocele sac compared to no sac result in decreased postnatal leg function following maternal fetal surgery for spina bifida aperta?
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.
Wilson
R Douglas
RD
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
Johnson
Mark P
MP
Bebbington
Michael
M
Flake
Alan W
AW
Hedrick
Holly L
HL
Sutton
Leslie N
LN
Adzick
N Scott
NS
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*