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Chen N, Li W, Min L, Huang Q, Bian J. Neurofibromatosis type 1 with huge intrathoracic meningoceles misdiagnosed as pleural effusion: A case report and literature review. J Cardiothorac Surg 2024; 19:303. [PMID: 38816890 PMCID: PMC11138057 DOI: 10.1186/s13019-024-02819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/25/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Neurofibromatosis type 1 is a genetic disease that affects multiple organs and systems, leading to various clinical manifestations. In Neurofibromatosis type 1, rare intrathoracic meningoceles often occur alongside bone dysplasia. These meningoceles contain cerebrospinal fluid and can be mistakenly diagnosed as 'pleural effusion'. CASE PRESENTATION In this case report, we mistakenly identified 'cerebrospinal fluid' as 'pleural effusion' and proceeded with drainage. This error posed significant risks to the patient and holds valuable implications for the future diagnosis and treatment of similar patients. CONCLUSIONS In patients with Neurofibromatosis type 1 complicated by spinal deformity, there is a high incidence of intrathoracic meningoceles. Treatment strategies may differ based on the specific features of the lesions, and collaboration among multiple disciplines can significantly improve patient outcomes.
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Affiliation(s)
- Ningyi Chen
- Department of Respiratory Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, People's Republic of China
| | - Wenjuan Li
- Department of Respiratory Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, People's Republic of China
| | - Lingfeng Min
- Department of Respiratory Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, People's Republic of China
| | - Qian Huang
- Department of Respiratory Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, People's Republic of China
| | - Jiarong Bian
- Department of Respiratory Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, People's Republic of China.
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Amuthabarathi M, Harshith K, Nagarajan K. Infantile Presentation of Lehman Syndrome with Multiple Lateral Meningoceles, Dural Ectasias, and Herniation of Conus: A Rare Case Report. J Pediatr Neurosci 2020; 15:111-115. [PMID: 33042242 PMCID: PMC7519747 DOI: 10.4103/jpn.jpn_152_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 05/16/2019] [Accepted: 11/18/2019] [Indexed: 11/04/2022] Open
Abstract
Lehman syndrome, or lateral meningocele syndrome, is a rare disorder of skeletal malformation, characterized by facial dysmorphism and multiple lateral meningoceles. We present a case of a 5-month-old girl who presented with macrocephaly, developmental delay, and failure to thrive. A whole spine magnetic resonance imaging was carried out, which showed multiple bilateral well-defined cystic masses within the neural foramina involving the entire spine, predominantly the thoracolumbar regions, with neural foraminal widening and dural ectasia suggestive of multiple lateral meningoceles.
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Affiliation(s)
- Mohan Amuthabarathi
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Kramadhari Harshith
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Krishnan Nagarajan
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
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Close LN, Park B, Woodroffe RW, Hitchon PW. Thoracic Meningocele and Cervical Syringomyelia Treated with Ventriculoperitoneal Shunt. World Neurosurg 2019; 129:322-326. [PMID: 31152885 DOI: 10.1016/j.wneu.2019.05.204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spinal meningocele is the herniation of dura mater and cerebrospinal fluid through a spinal defect, be it congenital, iatrogenic, or traumatic. Intrathoracic meningoceles are rare and are most commonly associated with neurofibromatosis. When indicated, surgical management of symptomatic thoracic meningocele is aimed at decreasing the size of the meningocele, which can be accomplished by a variety of procedures. CASE DESCRIPTION A 59-year-old woman with neurofibromatosis type 1 and a known thoracic meningocele was initially managed conservatively. However, she developed syringomyelia and subsequently became symptomatic from the syrinx. She was ultimately treated successfully with ventriculoperitoneal shunt. Shunting resulted in complete resolution of the syrinx, while the thoracic meningocele remained stable in size. CONCLUSIONS Ventriculoperitoneal shunt can be used to successfully treat a symptomatic syrinx in a patient with an asymptomatic thoracic meningocele. Alterations in normal cerebrospinal fluid flow dynamics from the thoracic meningocele likely contributed to the development of syringomyelia in this patient.
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Affiliation(s)
- Liesl N Close
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Brian Park
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Royce W Woodroffe
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Patrick W Hitchon
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
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Vigneswaran K, Sribnick EA, Reisner A, Chern J. Correction of Progressive Severe Cervical Kyphosis in a 21-Month-Old Patient With NF1: Surgical Technique and Review of Literature. Oper Neurosurg (Hagerstown) 2018; 15:46-53. [PMID: 29087535 DOI: 10.1093/ons/opx219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/17/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Severe cervical kyphosis in the setting of neurofibromatosis type 1 (NF1) is a rare manifestation of the disease in the pediatric population. Dystrophic and immature bone complicate the placement of hardware necessary for surgical correction of alignment and a review of the literature yields 4 cases of pediatric patients with NF1 requiring surgical intervention in which the youngest patient was 10 yr old. OBJECTIVE To report the case of an 11-mo-old female with NF1 who presented with a plexiform cervical neurofibroma and focal cervical kyphosis. A comprehensive review of the literature and a detailed description of nonsurgical and surgical management for this patient population is described. METHODS A literature review was completed for article reviewing management of pediatric patients with cervical spine injuries and NF1. The patient's chart was reviewed and the patient was followed for a year to provide adequate follow-up. Institutional Review Board (IRB)/ethics committee approval and patient consent were neither required nor sought for this study. RESULTS The literature was reviewed, summarized, and utilized for operative planning and postoperative management. Postoperative imaging and 1-yr follow-up imaging showed anterior construct and lateral mass fusion, restoration of cervical alignment, and no neurological deficits. CONCLUSION This is the youngest reported patient to have surgical cervical kyphosis correction in the setting of NF1. A review of the literature helped develop a long-term plan and shape a novel same-day front-back-front approach to restore alignment that will be of use to teams managing these complex patients in the future.
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Affiliation(s)
| | | | - Andrew Reisner
- Pediatric Neurosurgical Associates, Children's Healthcare of Atlanta, Georgia
| | - Joshua Chern
- Pediatric Neurosurgical Associates, Children's Healthcare of Atlanta, Georgia
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Das P, Goyal T, Hunt MA. Intrathoracic meningocele associated with neurofibromatosis Type 1 and a novel technique for surgical repair: case report. J Neurosurg Spine 2017. [PMID: 28621617 DOI: 10.3171/2017.2.spine16699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neurofibromatosis Type 1 (NF1) is a neurocutaneous disorder that can have associated spinal abnormalities related to both bone and dural dysplasia. Thoracic meningoceles are one spine anomaly associated with NF1, although they are a fairly uncommon pathology. Surgical techniques to treat these meningoceles, usually undertaken only when the patient is symptomatic, are targeted at decreasing the size of the protrusion and improving lung capacity. Surgical interventions discussed in the literature include shunting the pseudomeningocele, primary repair with laminectomy, thoracoscopic plication, and reinforcement of the closure with cement, muscle, or fascia. Authors here report the case of a 43-year-old woman with NF1 with worsening pulmonary function tests and in whom shunting of the pseudomeningocele failed. Subsequently, a posterolateral thoracotomy was performed. The dura mater was reconstructed and primarily closed. On this closure a Gore-Tex soft-tissue patch was placed along with polypropylene mesh and Evicel fibrin sealant, followed by titanium mesh. At the end of the procedure, a chest tube was left in place and therapeutic pneumoperitoneum was performed to decrease the dead space as the lung did not fully expand with positive-pressure ventilation. The patient's pulmonary function tests improved after the procedure. Thoracic meningoceles are uncommon and difficult pathologies to treat surgically. Although shunting is arguably the least invasive surgical option, it can fail in some patients. When it does fail, there are other options that require a multidisciplinary approach and careful attention to the dural closure and reinforcing layers.
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Affiliation(s)
- Paramita Das
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | - Tarini Goyal
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | - Matthew A Hunt
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
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Yusuf AS, Pillai A, Menon SK, Panikar D. Massive spontaneous hemothorax, giant intrathoracic meningocele, and kyphoscoliosis in neurofibromatosis type 1. J Surg Tech Case Rep 2014; 6:33-6. [PMID: 25013551 PMCID: PMC4090979 DOI: 10.4103/2006-8808.135151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neurofibromatosis type 1 (NF-1) is a heterogeneous autosomal dominant disease with an incidence ranging from 1 in 2500 to 1 in 3000. Rare intrathoracic vascular disorders resulting in massive spontaneous hemothorax with fatal consequences may occur in these patients, so also are various types of skeletal dysplasia which may result in dramatic presentations, posing management challenges to the attending physicians. We report the case of a 43-year-old woman with NF-1 who developed spontaneous massive hemothorax and was discovered to have a concurrent giant intrathoracic meningocele and thoracic kyphoscoliosis with severe vertebral dysplastic changes. Surgical treatment via a right thoracotomy with primary repair of the meningocele and spinal fusion with fibula graft resulted in good outcome. This case represents an extreme manifestation of this otherwise indolent disease in clinical practice.
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Affiliation(s)
- Ayodeji Salman Yusuf
- Department of Surgery, Neurosurgery Unit, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Ashok Pillai
- Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Sajesh K Menon
- Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Dilip Panikar
- Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
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7
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Zuo T, Ni Z, Zhou M, Huang C, Tang Z, Yang Z. Large intrathoracic meningocele in a patient with neurofibromatosis type 1. Asian Cardiovasc Thorac Ann 2013; 22:219-21. [DOI: 10.1177/0218492312475293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intrathoracic meningocele associated with neurofibromatosis type 1 is quite rare. We report the case of a Chinese women with a 20-day history of right-sided chest pain and sense of pressure on the chest. Computed tomography and magnetic resonance imaging indicated a homogeneous thin-walled cystic mass in the right rear mediastinum, ranging from the 1st to 5th thoracic segments. Surgery was performed to removal the meningomyelocele pouches and shunt the cyst to the subarachnoid region.
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Affiliation(s)
- Tao Zuo
- Department of Thoracic Surgery, Wuhan Medical Treatment Center, Wuhan, China
| | - Zhengyi Ni
- Department of Thoracic Surgery, Wuhan Medical Treatment Center, Wuhan, China
| | - Mi Zhou
- Department of Thoracic Surgery, Wuhan Medical Treatment Center, Wuhan, China
| | - Chaolin Huang
- Department of Thoracic Surgery, Wuhan Medical Treatment Center, Wuhan, China
| | - Zhongwen Tang
- Department of Thoracic Surgery, Wuhan Medical Treatment Center, Wuhan, China
| | - Zhifeng Yang
- Department of Thoracic Surgery, Wuhan Medical Treatment Center, Wuhan, China
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8
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Bisson EF, Sauri-Barraza JC, Niazi T, Schmidt MH. Synovial cysts of the cervicothoracic junction causing myelopathy: report of 3 cases and review of the literature. Neurosurg Focus 2013; 35:E3. [DOI: 10.3171/2013.3.focus1385] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Synovial cysts are uncommon pathological entities in patients with cervical degenerative spinal disease, and there are only a few reports in the literature. Treatment typically involves decompression; however, biomechanical data indicate that laminectomies in the cervical spine also result in cervical instability, specifically within the cervicothoracic junction, supporting the use of fusion as well. The authors describe the use of fusion with decompression in the treatment of 3 patients with cervicothoracic synovial cysts that presented in an acute fashion with associated myelopathy and neurological decline, and they review the diagnostic elements, histopathology, and treatment of these cysts. All 3 of the patients did well with decompression via a posterior approach with a single-level instrumented fusion from C-7 to T-1. Each patient regained complete neurological function and had no residual neurological deficits. These results are promising, although the sample size of 3 cases is too small to make any conclusive evaluations. Future studies incorporating Class I and Class II data are imperative to make firm conclusions regarding general management of this rare entity.
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Xie X, Yang X, Xu H, Wang F, Hu Y. Liquorrhoea associated with intrapelvic meningocele resection successfully treated by conservative therapy: a case report. J Biomed Res 2013; 27:239-41. [PMID: 23720680 PMCID: PMC3664731 DOI: 10.7555/jbr.27.20120017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 03/25/2012] [Accepted: 04/28/2012] [Indexed: 11/29/2022] Open
Abstract
Asymptomatic intrapelvic meningocele is rare. Here, we report the case of a 30-year-old Chinese man who underwent sigmoidectomy due to megacolon. During the operation, an intrapelvic cyst was found and resected. Meningocele was confirmed by histological examination. The patient recovered well postoperatively with the exception of liquorrhoea. Conservative therapy was initiated, including draining, anti-infection and specific posture maintenance. During the following week, liquorrhoea was generally relieved and the patient was discharged. This is the first known report of liquorrhoea associated with intrapelvic meningocele resection successfully treated by conservative therapy. Our case indicates that conservative treatment may be considered for similar cases so that a second surgery is avoided.
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Affiliation(s)
- Xiju Xie
- Department of General Surgery, the First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
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10
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Kumar BEP, Hegde KV, Kumari GL, Agrawal A. Bilateral multiple level lateral meningocoele. J Clin Imaging Sci 2013; 3:1. [PMID: 23607071 PMCID: PMC3625883 DOI: 10.4103/2156-7514.106613] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 07/31/2012] [Indexed: 11/04/2022] Open
Abstract
Lateral meningocoele is a very rare disorder characterized by extensions of the dura and arachnoid through an enlarged neural foramen. We report a case of a 23-year-old female with deformity of spine who presented with low back pain and no neurological deficits. A whole spine magnetic resonance imaging showed multiple well-defined cystic masses involving dorsal, lumbar, and sacral spinal levels bilaterally, with dural ectasia and neural foraminal widening suggestive of bilateral multiple level lateral meningocoele. The patient is being managed conservatively and is on regular follow-up.
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Affiliation(s)
- B E Panil Kumar
- Department of Radio-Diagnosis, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
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Kim YJ, Cho HM, Yoon CS, Lee CK, Lee TY, Seok JP. Surgical treatment of thoracic menigocele associated with neurofibromatosis and kyphoscoliosis. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2011; 44:383-6. [PMID: 22263195 PMCID: PMC3249347 DOI: 10.5090/kjtcs.2011.44.5.383] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 07/04/2011] [Accepted: 08/16/2011] [Indexed: 11/16/2022]
Abstract
A 46-year-old man presented with a lateral thoracic meningocele associated with cutaneous neurofibromatosis type I and kyphoscoliosis of the thoracic spine upon medical examination. In the majority of such cases, these meningoceles remain asymptomatic, but surgery is indicated when giant or symptomatic cysts are present. The large thoracic meningocele was successfully extirpated through the transthoracic approach in combination with lumbar puncture and cerebrospinal drainage for decompression of the cyst.
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Affiliation(s)
- Young-Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital, Korea
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12
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Morvan T, de Broucker F, de Broucker T. Subarachnoid hemorrhage in neurofibromatosis type 1: case report of extracranial cerebral aneurysm rupture into a meningocele. J Neuroradiol 2011; 38:125-8. [PMID: 21215453 DOI: 10.1016/j.neurad.2010.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 10/22/2010] [Accepted: 11/07/2010] [Indexed: 11/29/2022]
Abstract
Described here is a case of subarachnoid hemorrhage due to rupture of an extracranial vertebral artery (V3 segment) aneurysm in a patient with neurofibromatosis type 1 (NF-1). The pathophysiology of this never-before reported complication of NF-1 is examined in the light of a focused literature review and with illustrations characteristic of this unique case, involving complex malformations of the spine and meningeal spaces, as well as of the vertebral artery wall itself. All these abnormalities are directly related to the underlying NF-1 disease.
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Affiliation(s)
- T Morvan
- Service de neurologie et d'imagerie médicale, hôpital Delafontaine, 93200 Saint-Denis, France
| | - F de Broucker
- Service de neurologie, hôpital Delafontaine, 2, rue du Dr-Delafontaine, 93200 Saint-Denis, France
| | - T de Broucker
- Service de neurologie et d'imagerie médicale, hôpital Delafontaine, 93200 Saint-Denis, France.
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13
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Tanaka K, Shimizu K, Kakegawa S, Oshima K, Takeyoshi I. Cystoperitoneal shunt for a giant intrathoracic meningocele under local anesthesia. Ann Thorac Surg 2010; 91:317-9. [PMID: 21172550 DOI: 10.1016/j.athoracsur.2010.01.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 01/03/2010] [Accepted: 01/18/2010] [Indexed: 10/18/2022]
Abstract
Giant intrathoracic meningoceles are extremely rare, and the standard treatment for giant intrathoracic meningoceles remains controversial. We present the case of a patient with giant intrathoracic meningoceles associated with neurofibromatosis type I. Our patient had poor respiratory function because of the giant intrathoracic meningocele, so we performed a cystoperitoneal shunt under local anesthesia. We describe our cystoperitoneal shunt technique using an adjustable-pressure valve. This simple, minimally invasive treatment is a valuable alternative treatment option in patients at high operative risk, especially those with low respiratory function.
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Affiliation(s)
- Kazumi Tanaka
- Division of Thoracic and Visceral Organ Surgery, Gunma University, Graduate School of Medicine, Intensive Care Unit, Gunma University Hospital, Gunma, Japan
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14
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Rao ZX, Li J, Hang SQ, You C. Congenital spinal intradural arachnoid cyst associated with intrathoracic meningocele in a child. J Zhejiang Univ Sci B 2010; 11:429-32. [PMID: 20506573 DOI: 10.1631/jzus.b0900375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Congenital spinal intradural arachnoid cyst associated with intrathoracic meningocele is very rare. We report a case in a 9-year-old Chinese boy who presented with a two-week history of progressive paraparesis and gait ataxia. Magnetic resonance imaging revealed that a dorsal intradural extramedullary cystic lesion extended from T1 to T5 and compressed the spinal cord. A left lateral intrathoracic meningocele pouch was found incidentally at the level of T1. The arachnoid cyst as well as meningocele was removed and the spinal cord compression was relieved. Arachnoid cyst was confirmed by histological examination. The patient recovered well postoperatively. This is the second report of such a case in the world according to the available literature. The take-home message for our case is that the surgical approach should be individualized, depending on the size and location.
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Affiliation(s)
- Zheng-xi Rao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China
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15
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Cystoperitoneal shunt as alternative treatment for a giant thoracic meningocele in a patient with neurofibromatosis. ACTA ACUST UNITED AC 2008; 69:535-7. [DOI: 10.1016/j.surneu.2007.02.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 02/24/2007] [Indexed: 11/20/2022]
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16
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Chen CP. Syndromes, Disorders and Maternal Risk Factors Associated with Neural Tube Defects (II). Taiwan J Obstet Gynecol 2008; 47:10-7. [DOI: 10.1016/s1028-4559(08)60049-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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