Improvement in hindbrain herniation demonstrated by serial fetal magnetic resonance imaging following fetal surgery for myelomeningocele.

Department of Neurosurgery, Children's Hospital of Phildelphia, 10194, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 12/1999; 282(19):1826-31.
Source: PubMed


Hindbrain herniation occurs in a large percentage of children with myelomeningocele and is the leading cause of death in this population. The effect of early fetal closure of myelomeningocele on hindbrain herniation is unknown.
To determine whether early fetal closure of myelomeningocele affects hindbrain herniation.
Case series of patients undergoing fetal myelomeningocele closure with serial measurements of hindbrain herniation and a mean follow-up of 182 days.
Tertiary care medical center.
Ten patients undergoing fetal myelomeningocele closure at 22 to 25 weeks' gestation between March 1998 and February 1999.
Need for shunt placement; degree of hindbrain herniation (grades 0-3) found on magnetic resonance imaging (MRI) performed prior to surgery and 3 and 6 weeks after fetal surgery, as well as shortly after birth; gestational age at delivery.
All initial fetal MRI scans performed at 19 to 24 weeks' gestation showed significant (grade 3) cerebellar herniation and absence of spinal fluid spaces around the cerebellum. Six fetuses were delivered electively at 36 weeks' gestation after lung maturity was established. The other 4 were delivered prematurely, at 25, 30, 30, and 31 weeks of gestation, and the 25-week gestation neonate died. All 9 surviving neonates showed improvement in the hindbrain hernia at the 3-week postoperative fetal scan (grade 2, n = 4; grade 1, n = 5). On the postnatal scan, all patients showed grade 1 hindbrain herniation. Only 1 patient required placement of a ventriculoperitoneal shunt.
In this series of patients, fetal myelomeningocele closure resulted in improvement in hindbrain herniation as demonstrated by serial MRI scans.

20 Reads
  • Source
    • "Rarely, destructive lesions can be detected in fetuses with Chiari II malformations, such as germinal matrix hemorrhage. Following in utero repair of the myelomeningocele, improvement of hindbrain herniation can be observed on fetal MRI [67]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Fetal MRI is clinically performed to evaluate the brain in cases where an abnormality is detected by prenatal sonography. These most commonly include ventriculomegaly, abnormalities of the corpus callosum, and abnormalities of the posterior fossa. Fetal MRI is also increasingly performed to evaluate fetuses who have normal brain findings on prenatal sonogram but who are at increased risk for neurodevelopmental abnormalities, such as complicated monochorionic twin pregnancies. This paper will briefly discuss the common clinical conditions imaged by fetal MRI as well as recent advances in fetal MRI research.
    Pediatric Radiology 11/2009; 40(1):68-81. DOI:10.1007/s00247-009-1459-3 · 1.57 Impact Factor
  • Source
    • "Valuable experience has been gained as fetal therapeutics have been applied to lesions such as congenital diaphragmatic hernia, lung masses, distal urinary obstruction, and myelomeningocele (Harrison et al., 1990; Adzick et al., 1993, 1998; Sutton et al., 1999). In keeping with the fundamental principles of fetal intervention, investigators have targeted fetuses with the highest postnatal risk, in order to offer the greatest potential benefit to the neonate. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Neonates with hypoplastic left heart syndrome and intact or highly restrictive atrial septum have a high rate of mortality. We sought to assess the effect of prenatal intervention intended to create atrial septal defects in fetuses with this diagnosis. We reviewed the medical records and imaging of all fetuses undergoing intervention for atrial septal defect creation in the setting of hypoplastic left heart syndrome and intact atrial septum. The procedures were performed with a percutaneous cardiac puncture under the guidance of ultrasonography. For the 21 interventions, patient and procedural characteristics were analyzed to identify predictors of neonatal outcome. Of 21 procedures attempted between 24 and 34 weeks' gestation, 19 were technically successful. Fetal demise occurred in two cases. The size of the created defect varied and measured at least 3 mm in six fetuses. Among 19 neonates, a larger atrial septal defect was associated with higher oxygen saturation and less need for intervention prior to surgical single-ventricle palliation. Technically successful atrial septal defect creation in fetuses with hypoplastic left heart syndrome and intact atrial septum results in atrial septal defects of varying size; defects of at least 3 mm in diameter appear to confer postnatal benefit.
    Prenatal Diagnosis 11/2008; 28(11):1023-8. DOI:10.1002/pd.2114 · 3.27 Impact Factor
  • Source
    • "[22] "
    [Show abstract] [Hide abstract]
    ABSTRACT: These four individuals are recognized because at a critical point in the evolution of maternal-fetal surgery they contributed in ways that uniquely advanced progress in the field, enabling other researchers to make even greater discoveries. They were not the only significant contributors; there were many, too numerous to recount. Although their contributions were crucial, other researchers accomplished more. Among their peers, however, these four pioneers stand out because at a critical nexus their vision and perseverance carried researchers forward to a new level of excellence. We all follow in their footsteps.
    Clinics in Perinatology 10/2003; 30(3):439-47. DOI:10.1016/S0095-5108(03)00058-7 · 2.44 Impact Factor
Show more


20 Reads
Available from