To investigate the relationship of ventriculomegaly (VM) with gestational age (GA) and the severity of the associated Chiari II malformation.
The sonograms of 51 fetuses with myelomeningoceles were retrospectively reviewed. VM was judged to be present when the transverse ventricular atrial diameter was greater than 10 mm. The severity of the posterior fossa (PF) deformity was subjectively graded as mild, moderate, or severe. Thirty-four fetuses were scanned at < or = 24 weeks GA, and 17 were scanned at > 24 weeks GA.
The prevalence of VM was 61%. However, only 44% of fetuses < or = 24 weeks GA had VM, whereas 94% of fetuses > 24 weeks GA had VM. When compared with fetuses with mild PF deformities, fetuses with moderate or severe deformities had a higher prevalence of VM and the largest ventricles.
The prevalence of VM in fetuses with myelomeningoceles varies with both GA and the severity of the associated PF deformity. These observations may provide additional prognostic information once a myelomeningocele is detected at sonography.
[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 abstract][Hide abstract] ABSTRACT: Real time ultrasonography (US) is at present the main imaging technique in obstetrics. Indications for US examination are,
however, controversial. US examination is performed as a routine method in all pregnancies in most countries, and only in
well-defined clinical conditions in other countries.
[Show abstract][Hide abstract] ABSTRACT: It has been theorized that fetal myelomeningocele repair may reduce ongoing intrauterine injury and perhaps allow healing and regeneration of dysplastic neural tissue. We report on the postnatal imaging studies of the first 4 patients to have undergone intrauterine myelomeningocele repair at our institution.
Each of the 4 patients underwent postnatal sonographic and MRI. In addition, the postnatal ultrasounds of these 4 were compared to a group of retrospective controls.
MRI scans of the 4 experimental subjects revealed no evidence of hindbrain herniation while other stigmata of the Chiari-II malformation persisted. In comparison to the retrospective controls this absence of herniation was distinctly unusual.
Intrauterine myelomeningocele repair may reduce the degree of hindbrain herniation normally seen in patients with myelomeningocele. This raises the possibility that intrauterine repair may decrease the morbidity associated with the Chiari type-II malformation including brainstem dysfunction, hydrocephalus and syringomyelia.
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