CIRUGIA DE MIELOMENINGOCELE PDF

Mielomeningocele. Técnica Quirúrgica. Dr. Alberto Ramírez Espinoza. Lima-Perú – Duration: Alberto Ramírez Espinoza 18, views. CORRECCIÓN DEL MIELOMENINGOCELE POR MEDIO DE CIRUGÍA FETAL INTRAUTERINA. No description. CIRUGIA PRENATAL DE MIELOMENINGOCELE. Original Article A Randomized Trial of Prenatal versus Postnatal Repair of.

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Ruano R expert opinion. Overview of the management of myelomeningocele spina bifida.

In the prenatal-surgery group, one woman chose postnatal surgery after randomization, and two women returned home for delivery. On both the Bayley and Peabody motor scales, the prenatal-surgery group had better motor function than the postnatal-surgery group, even though those in the prenatal-surgery group had more severe anatomical levels of lesions.

Spina bifida is the most common of congenital anomalies of the central nervous system that are compatible with life. Study Procedures Women who were interested in the trial contacted the coordinating center, and if eligible, they were referred to one of the three clinical centers for evaluation and randomization after they provided written informed consent. Open neural tube defects: Analyses were performed according to the intention-to-treat principle.

One primary outcome was a composite of fetal or neonatal death or the need for placement of a cerebrospinal fluid shunt by the age of 12 months. Because this trial was unmasked and criteria for shunt placement vary widely, an independent committee of neurosurgeons, who were unaware of study-group assignments, reviewed the clinical and radiologic data for each child to determine whether criteria for shunt placement were met.

All surgeons used a stapling device with absorbable staples for uterine entry. Although the prenatal-surgery group had better outcomes than the postnatal-surgery group, not all infants benefited from the early intervention, and some had a poor neuromotor outcome. Folic acid supplementation in pregnancy. Human prenatal myelomeningocele repair by hysterotomy was first performed inand bymore than fetuses had undergone the procedure.

The severity of the neurologic disability in the lower limbs is correlated with the level of the injury to the spinal cord. Potential benefits of prenatal surgery must be balanced against the risks of prematurity and maternal morbidity. Ciba Found Symp ; Orthopedic issues in myelomeningocele spina bifida. Damage to the spinal cord and peripheral nerves usually is evident at birth and is irreversible despite early postnatal surgical repair. Childs Nerv Syst ; Sleep-disordered breathing in patients with myelomeningocele.

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Prenatal surgery for myelomeningocele reduced the need for shunting and improved motor outcomes at 30 months but was associated with maternal and fetal risks. Of the women who underwent randomization, this report is based on the findings in women who underwent randomization before July 1, i.

Surgical revisions are common to address shunt failure or infection.

The most frequent form is mielomeningcele, characterized by the extrusion of the spinal cord into a sac filled with cerebrospinal fluid, resulting in lifelong disability. The median survival time in open spina bifida. Centers for Disease Control and Prevention. The data and safety monitoring committee met on December 7,and recommended termination of the trial on the basis of efficacy of prenatal surgery. The second primary outcome, at 30 months, was a composite score of the Mental Development Index of the Bayley Scales of Infant Development II and the child’s motor function, with adjustment for lesion level.

We analyzed the time to shunt placement or meeting shunt criteria using Kaplan—Meier survival curves and log-rank tests.

Dev Med Child Neurol ; For the first primary end point, we mielomennigocele the National Institute milomeningocele Neurological Disorders and Stroke.

In our study, prenatal surgery for myelomeningocele reduced the need for shunting and improved motor outcomes at 30 months, but the early intervention was associated with both maternal and fetal morbidity.

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In the case of infants with low lumbar and sacral lesions, in whom less impairment in lower-limb function may be predicted, the normalization of hindbrain position and the minimization of the need for postnatal placement of a mielomeningcele fluid shunt may be the primary indication for surgery. Finally, for the children in this study, continued follow-up is needed to assess whether the early benefits are durable and to evaluate the dr of prenatal intervention on bowel and bladder continence, sexual function, and mental capacity.

McLone DG, et al. Early fetal movements in myelomeningocele. The rates of adverse neonatal outcomes were generally similar between the two groups.

The difference between the functional level and anatomical level in vertebral segments was calculated. Early data suggested a dramatic improvement in hindbrain herniation in comparison with historic controls but also showed an increased maternal risk, including preterm labor and uterine dehiscence, and a substantially increased risk of fetal or neonatal death and preterm birth.

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Routh JC, et al. The anatomical level miepomeningocele the lesion was determined by an independent group of radiologists on the basis of the month radiograph. Two perinatal deaths occurred in each group. Driscoll SY expert opinion. Results Patients From February through Decembera total of eligible women underwent randomization Figure 2Figure 2 Enrollment and Outcomes.

All children were evaluated at 12 and 30 months of age on the mielomeningocel of physical and neurologic examinations and developmental testing. One third of women who underwent prenatal surgery had an area of dehiscence or a very thin prenatal uterine surgery scar at the time of delivery. Since uterine dehiscence and rupture in a subsequent pregnancy are recognized risks of prenatal surgery,21 mothers who undergo prenatal surgery must understand that all subsequent pregnancies should be delivered by cesarean before the onset of labor.

We randomly assigned eligible women to undergo either prenatal surgery before 26 weeks of gestation or standard postnatal repair.

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There mielomeningocels no significant between-group differences in cognitive scores. We compared continuous variables using the Wilcoxon test and categorical variables using the chi-square test, Fisher’s exact test, or the Cochran—Armitage test for trend. Randomization to undergo either prenatal or postnatal surgery in a 1: For all secondary outcomes, a nominal P value of less than 0.

Trained independent pediatricians and psychologists who were unaware of study-group assignments and who reported directly to the coordinating center conducted the testing. Ranges of scores and implications of higher scores are provided in Table 4Table 4 Outcomes dde Children at 30 Months. Maternal morbidity and pregnancy complications that were related to prenatal surgery included oligohydramnios, chorioamniotic separation, placental abruption, and spontaneous membrane rupture.