title: Prenatal ultrasound evaluation of segmental level of neurological lesion in fetuses with myelomeningocele: development of a new technique.
abstract: OBJECTIVE
  To report our preliminary experience in the use of prenatal ultrasound examination to assess lower-limb movements in fetuses with myelomeningocele. We aimed to determine the accuracy of this method to establish the segmental level of neurological lesion, as this is the best known predictor of the future ability to walk.
  
  
  METHODS
  This was a preliminary, observational study including fetuses with myelomeningocele operated on prenatally. The patterns of movements present and absent in the affected fetuses' lower limbs were evaluated systematically by ultrasound examination. According to the known nerve function associated with each muscle group, the segmental level of neurological lesion was established before birth. The agreement for the segmental levels assigned, between the prenatal ultrasound technique and the classical neurological clinical examination after birth (gold standard), was tested using the weighed kappa (wκ) index.
  
  
  RESULTS
  Seventy-one fetuses with myelomeningocele were evaluated at the Hospital Universitari Vall d'Hebron. After counseling, the parents opted for prenatal surgery (26 cases), termination of pregnancy (43 cases) or postnatal repair (two cases). Five patients did not fulfil the inclusion criteria for prenatal surgery and three were excluded after birth. In the 18 fetuses that underwent surgery and were analyzed, the agreement between prenatal and postnatal segmental levels assigned was 91.7% for the right limb (wκ = 0.80) and 88.9% for the left limb (wκ = 0.73).
  
  
  CONCLUSIONS
  The agreement found between prenatal and postnatal assignment of level of lesion in this preliminary study suggests that neurological sonographic evaluation is feasible before birth. This may provide accurate individualized information about the motor function and future ambulation prognosis of fetuses with myelomeningocele.
authors: Maternal-Fetal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: E
authors: E
authors: Carreras
authors: Maternal-Fetal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: A
authors: A
authors: Maroto
authors: Maternal-Fetal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: T
authors: T
authors: Illescas
authors: Physical Medicine and Rehabilitation, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: M
authors: M
authors: Meléndez
authors: Maternal-Fetal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: S
authors: S
authors: Arévalo
authors: Paediatric Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: J L
authors: JL
authors: Peiró
authors: Paediatric Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: C G
authors: CG
authors: García-Fontecha
authors: Maternal-Fetal Medicine, Texas Children's Hospital, Houston, TX, USA.
authors: M
authors: M
authors: Belfort
authors: Physical Medicine and Rehabilitation, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: A
authors: A
authors: Cuxart
mesh_terms: D000328:Adult; D005260:Female; D005324:Fetal Movement; D005333:Fetus / Q000503:physiopathology*; D020233:Gait Disorders, Neurologic / Q000000981:diagnostic imaging* / Q000196:embryology / Q000209:etiology; D005865:Gestational Age; D006801:Humans; D035002:Lower Extremity / Q000000981:diagnostic imaging / Q000196:embryology; D008591:Meningomyelocele / Q000150:complications / Q000000981:diagnostic imaging* / Q000196:embryology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011379:Prognosis; D015203:Reproducibility of Results; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: fetal surgery; myelomeningocele; neurological examination; prenatal ultrasonography