Artikel
Initial experience with intrauterine MMC repair
Suche in Medline nach
Autoren
-
Heidi Bächli
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
-
Michael Elsässer
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
-
Herbert Fluhr
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
-
Jörg Rom
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
-
Johannes Pöschl
- Universitätsklinikum Heidelberg, Neonatologie, Heidelberg, Deutschland
-
Bernd Beedgen
- Universitätsklinikum Heidelberg, Neonatologie, Heidelberg, Deutschland
-
Sebastian Ronellenfitsch
- Universitätsklinikum Heidelberg, Neonatologie, Heidelberg, Deutschland
-
Christoph Lichtenstern
- Universitätsklinikum Heidelberg, Anaesthesie, Heidelberg, Deutschland
-
Rosemarie Schreckenberger
- Universitätsklinikum Heidelberg, Anaesthesie, Heidelberg, Deutschland
-
Ahmed El Damaty
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
-
Christof Sohn
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
-
Andreas W. Unterberg
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
|---|
Gliederung
Text
Objective: Fetal surgery has made significant progress in the treatment of severe congenital anomalies, especially in recent years, significantly improving the outcome of these children. The randomized multicenter clinical trial (MOMS-Study) published in 2011, showed clearly the benefit of prenatal versus postnatal MMC repair and demonstrated a decreased need for shunting (82% versus 40%), reversed Chiari II malformation (36% versus 4%) and improved motor function (32% versus 12%) including walking ability (42% versus 21%). Since 2016, an interdisciplinary team has been offering this innovative procedure and reports their experience.
Methods: Intrauterine MMC coverage was performed in the 24th and 25th week of gestation (GA) in 6 patients. All pregnant women received a fetal MRI preoperatively. The level of the lesion was 2x L3, 2x L4 and 2x L5. All patients had ventriculomegaly and Chiari II malformation. The MMC closure was done microsurgically in a three multi- layer repair. Primary skin closure was possible in 4 cases, 2x a patch (Epiflex) had to be used. The follow up was 1 year, 8, 6 and 5 months and 2 weeks.
Results: There were 6 fetal microsurgical MMC repairs, of which 5 were born. Another one will be expected next month. All MMC defects underwent successful repair without CSF leakage. The maternal age range from 20-36 years (average 27,5y). All 5 were delivered at our center. Average time of delivery at birth was 35 weeks (only 1 <31weeks, 5 between 35 and 37 weeks). Zero maternal or fetal mortality. Maternal complications were associated with 1 uterine dehiscence and 1 placental insufficiency with oligohydramnios. The infant birth weight ranged between 2480g-3040g, 1 preterm (31+0 weeks) with 1850g. There was no need for ventriculo-peritoneal shunting in all children, Chiari II malformation regressed in all patients and improvement in motor function was seen 4 patients.
Conclusion: Myelomeningocele (MMC) is the most frequent abnormality of the central nervous system and is often associated with long-term morbidity and mortality. The in-utero closure could not cure the defect and is neither free of complications nor risks but offers the unborn child the possibility of living with less disability and the chance for a better quality of life. The fetal MMC closure is a new promising therapeutic option for prenatally diagnosed spina bifida.
