Intrauterine myelomeningocele repair postnatal results and follow-up at 3.5 years of age--initial experience from a single reference service in Brazil.
OBJECTIVE
Present the outcomes of six cases submitted to intrauterine myelomeningocele (MMC) repair.


METHODS
Descriptive observational study of six children submitted to antenatal surgical repair of MMC between 26 and 27 weeks gestation. All deliveries were through cesarean section. The following neonatal variables were assessed: gestational age at delivery, birth weight, Apgar scores, need for intubation, duration of hospital stay and need for postnatal shunt procedures. After 3.5 years, the children were evaluated using the Columbia Mental Maturity Scale or Denver II tests and the Hoffer Ambulation Scale.


RESULTS
All deliveries were preterm at a mean gestational age of 32 + 4 weeks and mean birth weight was 1,942 g. Two infants had Apgar scores <7 at 1 min and 1 at 5 min. Ventricular-peritoneal shunts were placed in two cases. All six children are alive: five have normal cognitive development and one has a neuropsychomotor developmental delay. Two children had normal leg movements, a sacral functional level and are community ambulators. Three children had upper lumbar anatomical level lesions and one had a lower thoracic level lesion at the time of fetal surgery. One child, with an L1-L2 anatomical level lesion, in noambulatory and fully dependent on a wheelchair for mobility.


CONCLUSIONS
Antenatal surgical repair of MMC reduced the need for postnatal shunt placements. Despite preterm delivery, the cognitive development of most children at 3.5 years was normal. Antenatal surgery seemed to improve lower limb motor function in these cases.
Department of Obstetrics, Federal University of São Paulo, São Paulo, SP, Brazil.
Wagner Jou
WJ
Hisaba
Sérgio
S
Cavalheiro
Carlos Gilberto
CG
Almodim
Carolina Peixoto
CP
Borges
Tereza Cristina Carbonari
TC
de Faria
Edward
E
Araujo Júnior
Luciano Marcondes Machado
LM
Nardozza
Antonio Fernandes
AF
Moron
D001938:Brazil; D002675:Child, Preschool; D036861:Delivery, Obstetric; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D020883:Hysterotomy / Q000379:methods*; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008591:Meningomyelocele / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery; D018566:Pregnancy, High-Risk; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal