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Siahaan AMP, Susanto M, Lumbanraja SN, Ritonga DH. Long-term neurological cognitive, behavioral, functional, and quality of life outcomes after fetal myelomeningocele closure: a systematic review. Clin Exp Pediatr 2023; 66:38-45. [PMID: 36470279 PMCID: PMC9815938 DOI: 10.3345/cep.2022.01102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/07/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Myelomeningocele is a lifelong condition that features several comorbidities, such as hydrocephalus, scoliosis, club foot, and lower limb sensory and motor disabilities. Its management has progressed over time, ranging from supportive care to early postnatal closure to prenatal closure of the defect. Recent research discovered that fetal myelomeningocele closure (fMMC) provided superior neurological outcomes to those of postnatal closure. When performed at 12 months of age, fMMC can avert or delay the need for a ventriculoperitoneal shunt and reversed the hindbrain herniation. Moreover, fMMC reportedly enhanced motor function and mental development at 30 months of age. However, its long-term outcomes remain dubious. PURPOSE This systematic review aimed to determine the long-term neurological cognitive, behavioral, functional, and quality of life (QoL) outcomes after fMMC. METHODS The PubMed, Directory of Open Access Journals, EBSCO, and Cochrane databases were extensively searched for articles published in 2007-2022. Meta-analyses, clinical trials, and randomized controlled trials with at least 5 years of follow-up were given priority. RESULTS A total of 11 studies were included. Most studies revealed enhanced long-term cognitive, behavioral, functional, and QoL outcomes after fMMC. CONCLUSION Our results suggest that fMMC substantially enhanced patients' long-term neurological cognitive, behavioral, functional, and QoL outcomes.
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Affiliation(s)
| | - Martin Susanto
- Department of Neurosurgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Sarma Nursani Lumbanraja
- Department of Obstetrics & Gynecology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Dwi Herawati Ritonga
- Division of Pediatrics, H Amri Tambunan General Hospital, Lubuk Pakam, Indonesia
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Sacco A, Ushakov F, Thompson D, Peebles D, Pandya P, De Coppi P, Wimalasundera R, Attilakos G, David AL, Deprest J. Fetal surgery for open spina bifida. THE OBSTETRICIAN & GYNAECOLOGIST : THE JOURNAL FOR CONTINUING PROFESSIONAL DEVELOPMENT FROM THE ROYAL COLLEGE OF OBSTETRICIANS & GYNAECOLOGISTS 2019; 21:271-282. [PMID: 31787844 PMCID: PMC6876677 DOI: 10.1111/tog.12603] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 11/30/2022]
Abstract
KEY CONTENT Spina bifida is a congenital neurological condition with lifelong physical and mental effects.Open fetal repair of the spinal lesion has been shown to improve hindbrain herniation, ventriculoperitoneal shunting, independent mobility and bladder outcomes for the child and, despite an increased risk of prematurity, does not seem to increase the risk of neurodevelopmental impairment.Open fetal surgery is associated with maternal morbidity.Surgery at our institution is offered and performed according to internationally agreed criteria and protocols.Further evidence regarding long-term outcomes, fetoscopic repair and alternative techniques is awaited. LEARNING OBJECTIVES To understand the clinical effects, potential prevention and prenatal diagnosis of spina bifida.To understand the rationale and evidence supporting the benefits and risks of fetal repair of open spina bifida.To understand the criteria defining those who are likely to benefit from fetal surgery. ETHICAL ISSUES The concept of the fetus as a patient, and issues surrounding fetal death or the need for resuscitation during fetal surgery.The associated maternal morbidity in a procedure performed solely for the benefit of the fetus/child.The financial implications of new surgical treatments.
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Affiliation(s)
- Adalina Sacco
- Clinical Research Fellow, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
| | - Fred Ushakov
- Specialist in Fetal Medicine, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
| | - Dominic Thompson
- Consultant in Paediatric NeurosurgerySpecialist Neonatal and Paediatric SurgeryGreat Ormond Street Hospital for Children NHS Foundation TrustGreat Ormond StreetLondonWC1N 3JHUK
| | - Donald Peebles
- Professor of Fetal Medicine, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
| | - Pranav Pandya
- Consultant in Fetal Medicine, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
| | - Paolo De Coppi
- Professor of Paediatric SurgerySpecialist Neonatal and Paediatric SurgeryGreat Ormond Street Hospital for Children NHS Foundation TrustGreat Ormond StreetLondonWC1N 3JHUK
| | - Ruwan Wimalasundera
- Consultant in Fetal Medicine, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
| | - George Attilakos
- Consultant in Fetal Medicine, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
| | - Anna Louise David
- Professor of Fetal Medicine, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
| | - Jan Deprest
- Professor of Fetal Medicine, Fetal Medicine UnitElizabeth Garrett Anderson WingUniversity College London Hospital NHS Foundation Trust235 Euston RoadLondonNW1 2BUUK
- Professor of Obstetrics and GynaecologyClinical Department Obstetrics and GynaecologyUniversity Hospitals LeuvenLeuvenBelgium
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Inversetti A, Van der Veeken L, Thompson D, Jansen K, Van Calenbergh F, Joyeux L, Bosteels J, Deprest J. Neurodevelopmental outcome of children with spina bifida aperta repaired prenatally vs postnatally: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:293-301. [PMID: 30520204 DOI: 10.1002/uog.20188] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/08/2018] [Accepted: 11/23/2018] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To assess the neurodevelopmental outcome of children with spina bifida aperta (SBA) treated prenatally as compared to those treated postnatally. METHODS We performed a systematic review of the literature in PubMed/MEDLINE, EMBASE, Web of Science and The Cochrane Library, comparing the neurological outcome of infants with SBA treated prenatally vs postnatally. Only randomized controlled trials (RCTs) and non-randomized prospective controlled studies were included. The primary outcome assessed was neurodevelopmental impairment at the age of 1 year or later. Secondary outcomes were preterm birth, need for ventriculoperitoneal (VP) shunt by 12 months of age, absence of signs of hindbrain herniation at the first postnatal magnetic resonance imaging (MRI) evaluation and independent ambulation evaluated at 30 months. RESULTS Of 11 359 studies identified through the electronic search, six met the inclusion criteria and were assessed in full text and two, one RCT and one prospective cohort study, were ultimately included in the meta-analysis. Sensitivity analysis did not show any difference between the outcomes of the RCT alone and those of the pooled RCT and prospective cohort study. This allowed neurodevelopmental assessment of 213 children between 14 and 53 months of age. Neurodevelopment was assessed by the Bayley Scales of Infant Development II (BSID-II) mental development index corrected for chronological age, with a cut-off of ≥ 70 (representing no more than 2 SD below the mean). The presence of neurodevelopmental impairment was similar between children who underwent prenatal (25/105 (23.8%)) and those who had postnatal (30/108 (27.8%)) repair of SBA (odds ratio (OR), 0.82 (95% CI, 0.43-1.56); P = 0.54), although the risk of prematurity was higher in the prenatal-repair group (OR, 17.62 (95% CI, 7.60-40.87); P < 0.0001). For every two fetuses operated on before birth, there was, compared with those operated on after birth, one additional premature birth (number needed to harm = 2 (95% CI, 1-3)). The need for VP shunt placement by 12 months of age was lower in the prenatal-repair group (45/109 (41.3%)) than in children that had postnatal repair (93/112 (83.0%); OR, 0.14 (95% CI, 0.08-0.26); P < 0.0001). Data on neurodevelopmental impairment in children with a shunt were available only for patients from the prenatal-surgery group of the RCT; in this subgroup, the likelihood for impairment was similar between children who did (7/39 (17.9%)) and those who did not (4/48 (8.3%)) have shunt placement (P = 0.21). At first postnatal MRI evaluation, no signs of hindbrain herniation were detected in 28/88 (31.8%) children who were operated on prenatally compared with 4/89 (4.5%) who had postnatal repair (OR, 9.45 (95% CI, 3.12-28.64); P < 0.0001). Independent ambulation at 30 months was achieved by 41/109 (37.6%) children who underwent prenatal repair compared with 21/111 (18.9%) who had postnatal repair (OR, 2.59 (95% CI, 1.39-4.86); P = 0.003). CONCLUSION The risk of neurodevelopmental impairment in infants with SBA was similar between those who underwent prenatal and those who had postnatal surgical repair, despite an increased risk of prematurity in the prenatally repaired group. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Inversetti
- Academic Department Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - L Van der Veeken
- Academic Department Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - D Thompson
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - K Jansen
- Department of Pediatric Neurology, University Hospitals Leuven, Leuven, Belgium
| | - F Van Calenbergh
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - L Joyeux
- Academic Department Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - J Bosteels
- CEBAM, The Centre for Evidence-based Medicine, Cochrane Belgium, Academic Centre for General Practice, Leuven, Belgium
| | - J Deprest
- Academic Department Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
- Division Woman and Child, Fetal Medicine Unit, Clinical Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium
- Institute of Women's Health, University College London Hospitals, London, UK
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Joyeux L, Danzer E, Flake AW, Deprest J. Fetal surgery for spina bifida aperta. Arch Dis Child Fetal Neonatal Ed 2018; 103:F589-F595. [PMID: 30006470 DOI: 10.1136/archdischild-2018-315143] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 11/04/2022]
Abstract
Spina bifida aperta (SBA) is one of the most common congenital malformations. It can cause severe lifelong physical and neurodevelopmental disabilities. Experimental and clinical studies have shown that the neurological deficits associated with SBA are not simply caused by incomplete neurulation at the level of the lesion. Additional damage is caused by prolonged exposure of the spinal cord and nerves to the intrauterine environment and a suction gradient due to cerebrospinal fluid leakage, leading to progressive downward displacement of the hindbrain. This natural history can be reversed by prenatal repair. A randomised controlled trial demonstrated that mid-gestational maternal-fetal surgery for SBA decreases the need for ventriculoperitoneal shunting and hindbrain herniation at 12 months and improves neurological motor function at 30 months of age. This came at the price of maternal and fetal risks, the most relevant ones being increased prematurity and a persistent uterine corporeal scar. Recently minimally invasive fetal approaches have been introduced clinically yet they lack extensive experimental or clinical trials. We aim to provide clinicians with the essential information necessary to counsel SBA parents as the basis for considering referral of selected patients to expert fetal surgery centres. We review the reported clinical outcomes and discuss recent developments of potentially less invasive fetal SBA approaches.
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Affiliation(s)
- Luc Joyeux
- Academic Department Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.,Center for Surgical Technologies, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Enrico Danzer
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Center for Fetal Research, Abramson Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alan W Flake
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Center for Fetal Research, Abramson Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jan Deprest
- Academic Department Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.,Center for Surgical Technologies, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.,Division Woman and Child, Fetal Medicine Unit, Clinical Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium.,Institute of Women's Health, University College London Hospitals, London, UK
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Kabagambe SK, Chen YJ, Vanover MA, Saadai P, Farmer DL. New directions in fetal surgery for myelomeningocele. Childs Nerv Syst 2017; 33:1185-1190. [PMID: 28497181 DOI: 10.1007/s00381-017-3438-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/28/2017] [Indexed: 01/07/2023]
Abstract
The treatment of children with myelomeningocele (MMC) has improved over time, from supportive management to early postnatal closure to prenatal repair of the defect. The Management of Myelomeningocele Study (MOMS) showed that prenatal repair of MMC resulted in improved neurological outcomes compared to postnatal closure. Follow-up studies showed that prenatal repair was, as with any other fetal intervention, associated with higher rates of obstetrical complications. There was no significant difference in urological outcomes. Long-term follow-up of ambulatory status, executive functioning, and urological outcomes is needed to determine the durable effects of fetal MMC repair on mobility, functional independence, and the prevalence of renal insufficiency in patients with MMC who survive to adulthood. The future of fetal MMC repair consists of developing strategies to reduce maternal morbidity and improve infant outcomes. Fetoscopic MMC repair has been suggested as an alternative to open repair that may reduce obstetrical complications and the need for cesarean delivery in subsequent pregnancies. Translational research using mesenchymal stromal cells to augment fetal repair of ovine MMC has shown improvement in motor function.
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Affiliation(s)
- Sandra K Kabagambe
- Department of Surgery, University of California, Davis Health Systems, 2315 Stockton Blvd, OP512, Sacramento, CA, 95817, USA.
| | - Y Julia Chen
- Department of Surgery, University of California, Davis Health Systems, 2315 Stockton Blvd, OP512, Sacramento, CA, 95817, USA
| | - Melissa A Vanover
- Department of Surgery, University of California, Davis Health Systems, 2315 Stockton Blvd, OP512, Sacramento, CA, 95817, USA
| | - Payam Saadai
- Department of Surgery, University of California, Davis Health Systems, 2315 Stockton Blvd, OP512, Sacramento, CA, 95817, USA
| | - Diana L Farmer
- Department of Surgery, University of California, Davis Health Systems, 2315 Stockton Blvd, OP512, Sacramento, CA, 95817, USA
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Araujo Júnior E, Tonni G, Martins WP. Outcomes of infants followed-up at least 12 months after fetal open and endoscopic surgery for meningomyelocele: a systematic review and meta-analysis. J Evid Based Med 2016; 9:125-135. [PMID: 27305320 DOI: 10.1111/jebm.12207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/09/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess the outcomes of infants followed-up at least 12 months after open and endoscopic fetal surgery for the treatment of spina bifida. METHODS A searching in The Cochrane Library, LILACS, PubMed and SCOPUS databases for fetal meningomyelocele (MMC) open or endoscopic surgery in humans from 2003 on-wards with follow-up at least 12 months. The rate of the estimated proportions was evaluated by the 95% confidence interval (CI). RESULTS A total of 19 studies were finally included (17 open and 2 endoscopic surgery). The results suggested that the rate for ventriculoperitoneal shunt placement were 40% (29%, 51%) versus 45% (34%, 56%) for open surgery group and endoscopic surgery group. The rate of hindbrain herniation reversal was 34% (28%, 52%) versus 86% (49%, 97%), the lower extremity function rates for both groups were 47% (30%, 64%) versus 86% (49%, 97%), and bladder dysfunction rates for both groups were 72% (53%, 88%) versus 29% (8%, 64%), respectively. Open and endoscopic fetal surgery for MMC presented similar ventriculoperitoneal shunt rates. CONCLUSION Open and endoscopic fetal surgery for MMC presented similar ventriculoperitoneal shunt rates in infants followed at least 12 months.
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Affiliation(s)
- Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Gabriele Tonni
- Department of Obstetrics and Gynecology, Guastalla Civil Hospital, AUSL Reggio Emilia, Italy
| | - Wellington P Martins
- Department of Obstetrics and Gynecology, Ribeirão Preto School of Medicine, São Paulo University (FMRP-USP), Ribeirão Preto, SP, Brazil
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Advances in spina bifida care: from the womb to adulthood. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0046-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Joyeux L, Chalouhi GE, Ville Y, Sapin E. [Maternal-fetal surgery for spina bifida: future perspectives]. ACTA ACUST UNITED AC 2014; 43:443-54. [PMID: 24582882 DOI: 10.1016/j.jgyn.2014.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/14/2014] [Accepted: 01/21/2014] [Indexed: 12/29/2022]
Abstract
Open spina bifida or myelomeningocele (MMC) is a frequent congenital abnormality (450 cases per year in France) associated with high morbidity. Immediate postnatal surgery is aimed at covering the exposed spinal cord, preventing infection, treating hydrocephalus with a ventricular shunt. MMC surgical techniques haven't achieved any major progress in the past decades. Numerous experimental and clinical studies have demonstrated the MMC "two-hit" hypothetic pathogenesis: a primary embryonic congenital abnormality of the nervous system due to a failure in the closure of the developing neural tube, followed by secondary damages of spinal cord and nerves caused by long-term exposure to amniotic fluid. This malformation frequently develops cranial consequences, i.e. hydrocephalus and Chiari II malformation, due to leakage of cerebrospinal fluid. After 30 years of research, a randomized trial published in February 2011 proved open maternal-fetal surgery (OMFS) for MMC to be a real therapeutic option. Comparing prenatal to postnatal surgery, it confirmed better outcomes of MMC children after a follow up of 2.5 years: enhancement of lower limb motor function, decrease of the degree of hindbrain herniation associated with the Chiari II malformation and the need for shunting. At 5 years of age, MMC children operated prenatally seems to have better neurocognitive, motor and bladder-sphincter outcomes than those operated postnatally. However, risks of OMFS exist: prematurity for the fetus and a double hysterotomy at approximately 3-month interval for the mother. Nowadays, it seems crucial to inform parents of MMC patients about OMFS and to offer it in France. Future research will improve our understanding of MMC pathophysiology and evaluate long-term outcomes of OMFS. Tomorrow's prenatal surgery will be less invasive and more premature using endoscopic, robotic or percutaneous techniques. Beforehand, Achilles' heel of maternal-fetal surgery, i.e. preterm premature rupture of membranes, preterm labor and preterm birth, must be solved.
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Affiliation(s)
- L Joyeux
- Service de chirurgie pédiatrique, hôpital d'enfants, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon, France.
| | - G E Chalouhi
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - Y Ville
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - E Sapin
- Service de chirurgie pédiatrique, hôpital d'enfants, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon, France
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Veenboer PW, Huisman J, Chrzan RJ, Kuijper CF, Dik P, de Kort LM, de Jong TP. Behavioral Effects of Long-Term Antimuscarinic Use in Patients with Spinal Dysraphism: A Case Control Study. J Urol 2013; 190:2228-32. [DOI: 10.1016/j.juro.2013.06.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Paul W. Veenboer
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jaap Huisman
- Department of Medical Psychology and Social Work, Wilhelmina Kinderziekenhuis Utrecht, Utrecht, The Netherlands
| | - Rafal J. Chrzan
- Pediatric Urology Center, University Children’s Hospital, Wilhelmina Kinderziekenhuis Utrecht, Utrecht, The Netherlands
- Pediatric Urology Center, University Children's Hospital, Emma Kinderziekenhuis Amsterdam, Amsterdam, The Netherlands
| | - Caroline F. Kuijper
- Pediatric Urology Center, University Children’s Hospital, Wilhelmina Kinderziekenhuis Utrecht, Utrecht, The Netherlands
- Pediatric Urology Center, University Children's Hospital, Emma Kinderziekenhuis Amsterdam, Amsterdam, The Netherlands
| | - Pieter Dik
- Pediatric Urology Center, University Children’s Hospital, Wilhelmina Kinderziekenhuis Utrecht, Utrecht, The Netherlands
- Pediatric Urology Center, University Children's Hospital, Emma Kinderziekenhuis Amsterdam, Amsterdam, The Netherlands
| | | | - Tom P.V.M. de Jong
- Pediatric Urology Center, University Children’s Hospital, Wilhelmina Kinderziekenhuis Utrecht, Utrecht, The Netherlands
- Pediatric Urology Center, University Children's Hospital, Emma Kinderziekenhuis Amsterdam, Amsterdam, The Netherlands
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Garabedian C, Di Rocco F, Fallet-Bianco C, Zerah M, Jouannic JM. [Prenatal repair of myelomeningocele: State of the art]. ACTA ACUST UNITED AC 2013; 42:227-31. [PMID: 23453920 DOI: 10.1016/j.jgyn.2012.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/22/2012] [Accepted: 10/25/2012] [Indexed: 12/20/2022]
Abstract
Myelomeningocele is characterized by the extrusion of the spinal cord into a sac filled with cerebrospinal fluid. One part of the postnatal disabilities could be related to the spinal damage and to the cerebral repercussion of the leak of cerebrospinal fluid from the defect. Several experimental studies in animals have demonstrated that a surgical repair of the lesion at middle gestation reduced the postnatal disabilities. These results were confirmed in humans by the Management of Myelomeningocele (MOM) Trial. However, the prenatal surgical repair is associated with maternal and fetal morbidity.
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Affiliation(s)
- C Garabedian
- Pôle de périnatalité, centre pluridisciplinaire de diagnostic prénatal de l'Est parisien, université Paris 6, hôpital Trousseau, AP-HP, 26, avenue Arnold-Netter, 75012 Paris, France
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