Evaluation and Disposition of Fetal Myelomeningocele Repair Candidates: A Large Referral Center Experience.

摘要: BACKGROUND Fetal myelomeningocele (fMMC) repair yields superior outcomes to postnatal and is increasingly offered at select fetal centers. OBJECTIVES To report the fMMC referral process from initial evaluation surgical intervention in a large center. METHODS We conducted retrospective cohort study of patients referred Texas Children's Center for between September 2013 January 2018, reviewing final disposition. The stepwise included phone interview followed by multidisciplinary consultation our modified Management Myelomeningocele Study inclusion exclusion criteria allow maternal body mass index 35-40 on an individual basis. RESULTS A total 204 referrals were contacted interview; 175 (86%) pursued outpatient evaluation, 80 (46%) them qualified repair. Among eligible patients, 37 underwent fetoscopic repair, 20 (25%) open 17 (21%) declined prenatal surgery. Of 89 noneligible (53%) excluded upon 64 (72%) (19%) reasons. No hindbrain herniation (16%) BMI and/or hypertension (5%) most common reasons exclusion, respectively. 31% population CONCLUSIONS small percentage ultimately undergo Stepwise teams are key success programs.