A new look at myelomeningoceles: functional level, vertebral level, shunting, and the implications for fetal intervention.

摘要: Objective. Previous reports have suggested that 80% to 85% of patients who a myelomeningocele (MMC) and undergo surgical repair after birth develop hydrocephalus require the placement ventricular shunt. However, rate shunting as function spinal level is not well established. We sought determine distribution postnatally repaired MMC lesions characterized by both functional radiologic assessment, incidence when were categorized according these 2 methods. Methods. A retrospective chart review 297 born with open MMCs followed in spina bifida clinic at Children’s Hospital Philadelphia was performed. The presence or absence shunt determined for each patient. Functional best-recorded neurologic examination vertebral spine radiographs. Results. overall 81%. lesion significantly affected shunting, more cephalad correlating higher rates. This true categorizations. found among sacral rather than criteria. In 86% patients, be equal (worse) level. Conclusions. study describes natural history relation Fetal closure being performed some centers an attempt decrease improve leg selected patients. present data may serve comparison group aid design analysis prospective trial assess efficacy this new procedure.