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Talamonti G. Reflections upon the intrauterine repair of myelomeningocele. Childs Nerv Syst 2024; 40:1571-1575. [PMID: 38514517 DOI: 10.1007/s00381-024-06365-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
The intrauterine repair of myelomeningocele presents certain advantages and has gained widespread acceptance. It significantly reduces the incidence of Chiari-2 anomalies and hydrocephalus, and it is thought to enhance the neurologic outcome. Nevertheless, several issues remain unsettled and there are no negligible disadvantages. After working with patients with myelomeningocele for 30 years, I thought about how we currently treat them. There are ethical, organizational, neurological, obstetrical, and postnatal aspects worth discussing.
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Affiliation(s)
- Giuseppe Talamonti
- Dep. of Neurosurgery, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
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Marcati E, Meccariello G, Mastino L, Picano M, Giorgi PD, Talamonti G. Myelomeningocele: Long-Term Neurosurgical Management. Adv Tech Stand Neurosurg 2024; 49:95-122. [PMID: 38700682 DOI: 10.1007/978-3-031-42398-7_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Open spina bifida, also known as myelomeningocele (MMC), is the most challenging and severe birth defect of the central nervous system compatible with life and it is due to a failure in the dorsal fusion of the nascent neural tube during embryonic development. MMC is often accompanied by a constellation of collateral conditions, including hydrocephalus, Arnold - Chiari II malformation, brainstem disfunction, hydrosyringomyelia, tethered cord syndrome and scoliosis. Beyond early surgical repair of the dorsal defect, MMC requires lifelong cares. Several additional surgical procedures are generally necessary to improve the long-term outcomes of patients affected by MMC and multidisciplinary evaluations are crucial for early identification and management of the various medical condition that can accompany this pathology. In this chapter, the most common pathological entities associated with MMC are illustrated, focusing on clinical manifestations, treatment strategies and follow up recommendations.
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Affiliation(s)
- E Marcati
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
| | - G Meccariello
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
| | - L Mastino
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
| | - M Picano
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
| | - P D Giorgi
- Department of Orthopedics, ASST Niguarda Hospital, Milan, Italy
| | - G Talamonti
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
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Licci M, Zaed I, Beuriat PA, Szathmari A, Guibaud L, Mottolese C, Di Rocco F. CSF shunting in myelomeningocele-related hydrocephalus and the role of prenatal imaging. Childs Nerv Syst 2021; 37:3417-3428. [PMID: 34076708 DOI: 10.1007/s00381-021-05217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/13/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Hydrocephalus is commonly associated with myelomeningocele (MMC). Indication and timing of cerebrospinal fluid (CSF) shunting are still a topic of discussion. The aim of this study was to investigate whether the analysis of prenatal cerebral imaging studies could provide information that is predictive of the necessity of CSF shunting in the postnatal period. MATERIAL AND METHODS Among 73 infants operated on because of MMC between January 2003 and June 2020, 50 had undergone prenatal and postnatal MRI studies and were considered for analysis. For each patient, frontal horn width, atrial ventricle diameter, third ventricle diameter, and subarachnoid spaces (sinocortical width, craniocortical width, and the interhemispheric width) have been measured on prenatal, postnatal, and a follow-up MRI study. The need of CSF shunting device placement in relation to prenatal and early postnatal MRI data was investigated. RESULTS Of the 50 infants, 31 (62%) developed a progressive hydrocephalus. Of these, 30 needed a CSF shunt and the majority of them (n=29) was operated on within 28 days after birth. One patient needed CSF shunt implantation at 45 days after birth and one child developed a late progressive hydrocephalus, successfully treated by ETV alone, at 14.2 months of age. All patients with an atrial ventricle diameter greater than 1.9 cm and a 3rd ventricle diameter larger than 0.3 cm on antenatal third trimester imaging have undergone CSF shunting within 1 month after birth. Conversely, all the children that did not undergo a CSF shunt placement showed an atrial cerebral ventricle diameter inferior to 1.2 cm and a 3rd ventricle width < 0.3 cm on antenatal imaging. Frontal horn width and subarachnoid CSF spaces' evolution did not seem to play a role. CONCLUSION The prenatal MRI assessment of the associated prenatal ventriculomegaly in MMC provides parameters that have a predictive value heralding the probability of a CSF diversion procedure after birth. In the same way, the analysis of intrauterine MRI studies may identify those subjects that are less at risk of developing a progressive hydrocephalus after birth, therefore encouraging a more cautious attitude towards the early implantation of CSF shunting devices in the current clinical practice.
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Affiliation(s)
- Maria Licci
- "Centre de compétence" MAVEM, Department of Pediatric Neurosurgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, 69003, Lyon, France
| | - Ismail Zaed
- "Centre de compétence" MAVEM, Department of Pediatric Neurosurgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, 69003, Lyon, France
| | - Pierre-Aurélien Beuriat
- "Centre de compétence" MAVEM, Department of Pediatric Neurosurgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, 69003, Lyon, France
| | - Alexandru Szathmari
- "Centre de compétence" MAVEM, Department of Pediatric Neurosurgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, 69003, Lyon, France.,Department of Pediatric Radiology, Hôpital Femme Mère-Enfant, Hospices civils de Lyon, 69003, Lyon, France
| | - Laurent Guibaud
- Department of Pediatric Radiology, Hôpital Femme Mère-Enfant, Hospices civils de Lyon, 69003, Lyon, France
| | - Carmine Mottolese
- "Centre de compétence" MAVEM, Department of Pediatric Neurosurgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, 69003, Lyon, France.,Department of Pediatric Radiology, Hôpital Femme Mère-Enfant, Hospices civils de Lyon, 69003, Lyon, France
| | - Federico Di Rocco
- "Centre de compétence" MAVEM, Department of Pediatric Neurosurgery, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon, 69003, Lyon, France.
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Shobeiri P, Presedo A, Karimi A, Momtazmanesh S, Vosoughi F, Nabian MH. Orthopedic management of myelomeningocele with a multidisciplinary approach: a systematic review of the literature. J Orthop Surg Res 2021; 16:494. [PMID: 34389028 PMCID: PMC8361640 DOI: 10.1186/s13018-021-02643-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Myelomeningocele (MMC) is the most common and severe form of spina bifida and imposes a significant burden on patients and the healthcare system. Recently, the multidisciplinary management of MMC has become popular. Herein, we aimed to review the orthopedic management, outcomes, and complications of the of patients with MMC eyeing a multidisciplinary approach. Methods We searched PubMed and EMBASE to find relevant studies published before August 2020. All studies that included clinical management of MMC patients and published earlier than 2000 were considered for review on the condition that they reported at least one orthopedic intervention and the rate of complications. We excluded review articles, case reports, case series, letters, commentaries, editorials, and conference abstracts. The primary and secondary goals of our review were to report the outcomes and complication rates of multidisciplinary management for MMC patients. Results Twenty-six studies included data for the management of 229,791 patients with MMC and were selected. Sixteen studies reported multidisciplinary management in addition to orthopedic management. From those, 11 (42.31%) included urologic management, 13 (50%) neurosurgical management, 11 (42.31%) neurologic management, and 5 (19.23%) gastrointestinal management. All studies included postnatal operations and related management. No randomized clinical trial was found in our search. Conclusion Orthopedic approaches play a key role in MMC management by alleviating spinal deformities, particularly scoliosis, and hip, foot, and ankle complications. However, the most appropriate management, whether surgical or non-surgical, may vary for different patients, given disease severity and the age of patients. Graphical abstract ![]()
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Affiliation(s)
- Parnian Shobeiri
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ana Presedo
- Department of Pediatric Orthopedics, Hôpital Robert Debre, Paris, France
| | - Amirali Karimi
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sara Momtazmanesh
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Fardis Vosoughi
- Department of Orthopedic and trauma surgery, Shariati Hospital and School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Hossein Nabian
- Department of Orthopedic and trauma surgery, Shariati Hospital and School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran. .,Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Paslaru FG, Panaitescu AM, Iancu G, Veduta A, Gica N, Paslaru AC, Gheorghiu A, Peltecu G, Gorgan RM. Myelomeningocele Surgery over the 10 Years Following the MOMS Trial: A Systematic Review of Outcomes in Prenatal versus Postnatal Surgical Repair. ACTA ACUST UNITED AC 2021; 57:medicina57070707. [PMID: 34356988 PMCID: PMC8307221 DOI: 10.3390/medicina57070707] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 12/04/2022]
Abstract
Background and Objectives: Myelomeningocele is the most severe form of spina bifida, a congenital neural tube defect arising from an incomplete neural tube closure during early development with damage worsening with advancing gestational age. The Management of Myelomeningocele Study (MOMS) Trial proved that surgery performed before 26 weeks of gestation significantly improved the prognosis, significantly changing treatment paradigms. This article aims to provide a review of the changes and updates in spina bifida repair over the 10-year period following the MOMS Trial. Material and methods: We performed a systematic review in the PubMed and Cochrane databases as well as a hand-search of high-impact journals using the reference list of all identified articles, searching for randomized controlled trials and observational studies. Results: We identified 27 articles published between 2011 and 2021 that fulfilled the inclusion criteria and review them in the present study. Conclusions: With growing experience and with the improvement of prenatal open and fetoscopic techniques, the outcome of SB-associated conditions could be improved and the risks to both the mother and the fetus reduced. A continuous follow-up of the treated infants and further randomized trials are essential to study the complications and advantages or disadvantages of any given treatment strategy.
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Affiliation(s)
- Francesca Gabriela Paslaru
- Neurosurgical Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 041915 Bucharest, Romania; (F.G.P.); (A.G.); (R.M.G.)
- Neurosurgery Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Anca Maria Panaitescu
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (G.I.); (A.V.); (N.G.); (G.P.)
- Obstetrics and Gynecology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Correspondence: ; Tel.: +40-23188930
| | - George Iancu
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (G.I.); (A.V.); (N.G.); (G.P.)
- Obstetrics and Gynecology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alina Veduta
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (G.I.); (A.V.); (N.G.); (G.P.)
| | - Nicolae Gica
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (G.I.); (A.V.); (N.G.); (G.P.)
- Obstetrics and Gynecology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alexandru Catalin Paslaru
- Physiology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Anamaria Gheorghiu
- Neurosurgical Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 041915 Bucharest, Romania; (F.G.P.); (A.G.); (R.M.G.)
| | - Gheorghe Peltecu
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (G.I.); (A.V.); (N.G.); (G.P.)
- Obstetrics and Gynecology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Radu Mircea Gorgan
- Neurosurgical Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 041915 Bucharest, Romania; (F.G.P.); (A.G.); (R.M.G.)
- Neurosurgery Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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