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Dugas A, Guilbaud L, de Saint‐Denis T, Lallemant‐Dudek P, Simonnet H, Vande Perre S, Blondiaux E, Garel C, Jouannic J. Outcome of Children With Prenatally Diagnosed Saccular Limited Dorsal Myeloschisis: The Importance of Accurate Diagnosis. Prenat Diagn 2025; 45:668-675. [PMID: 40237726 PMCID: PMC12054388 DOI: 10.1002/pd.6800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Revised: 02/14/2025] [Accepted: 04/08/2025] [Indexed: 04/18/2025]
Abstract
OBJECTIVE To describe outcomes at 36 months of age in children with prenatally diagnosed Limited Dorsal Myeloschisis (LDM) and compared to Myelomeningocele (MMC). METHOD This was a retrospective study of all successive patients with postnatal confirmation of a prenatal diagnosis of isolated LDM who were referred to a French National Reference center from 2014 to 2023 compared with MMC cases. Postnatal evaluation at 36 months of both dysraphisms comprised standardized multidisciplinary evaluations. RESULTS Of the 245 fetuses referred with suspected MMC, 19 were prenatally diagnosed with LDM. Nine children reached 36 (± 4) months of age. All were walking. Two required clean intermittent catheterization (CIC) and three required laxatives. Sphincter functions seem to be more dysfunctional in the case of sacral LDM. None were reported to have a ventricular shunt nor having neurodevelopment impairment. The LDM children differed from the MMC children in all functions with significantly more asymptomatic children in the LDM group (LDM: 5/9 vs. MMC: 0/12, p < 0.01), better motor (independent walking; LDM: 7/9 vs. MMC: 2/12; p < 0.01), urinary (need for CIC; LDM: 2/9 vs. MMC: 10/12; p < 0.01) and cognitive (neurodevelopmental impairment; LDM: 0/9 vs. MMC: 4/12, p = 0.10) functions. CONCLUSION LDM show better motor, urinary, and cognitive functions than MMC.
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Affiliation(s)
- Anaïs Dugas
- Department of Fetal MedicineDMU ORIGYNETrousseau HospitalAP‐HPSorbonne UniversityParisFrance
| | - Lucie Guilbaud
- Department of Fetal MedicineDMU ORIGYNETrousseau HospitalAP‐HPSorbonne UniversityParisFrance
- Trousseau HospitalAP‐HPNational Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (Spin@ Center)ParisFrance
| | - Timothée de Saint‐Denis
- European Reference Network ITHACA—Working Group “Spina Bifida and Other Dysraphisms”France
- Pediatric Orthopaedic DepartmentTrousseau HospitalAP‐HPSorbonne UniversityParisFrance
| | - Pauline Lallemant‐Dudek
- Trousseau HospitalAP‐HPNational Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (Spin@ Center)ParisFrance
- Department of Physical Medicine and RehabilitationTrousseau HospitalAP‐HPSorbonne UniversityParisFrance
| | - Hina Simonnet
- Trousseau HospitalAP‐HPNational Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (Spin@ Center)ParisFrance
- Department of Physical Medicine and RehabilitationTrousseau HospitalAP‐HPSorbonne UniversityParisFrance
| | - Saskia Vande Perre
- Trousseau HospitalAP‐HPNational Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (Spin@ Center)ParisFrance
- Department of Pediatric RadiologyTrousseau HospitalAP‐HPSorbonne UniversityParisFrance
| | - Eléonore Blondiaux
- Trousseau HospitalAP‐HPNational Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (Spin@ Center)ParisFrance
- Department of Pediatric RadiologyTrousseau HospitalAP‐HPSorbonne UniversityParisFrance
| | - Catherine Garel
- Trousseau HospitalAP‐HPNational Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (Spin@ Center)ParisFrance
- Department of Pediatric RadiologyTrousseau HospitalAP‐HPSorbonne UniversityParisFrance
| | - Jean‐Marie Jouannic
- Department of Fetal MedicineDMU ORIGYNETrousseau HospitalAP‐HPSorbonne UniversityParisFrance
- Trousseau HospitalAP‐HPNational Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (Spin@ Center)ParisFrance
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Castillo J, Locastro MM, Corroenne R, Malhotra A, Van Speybroeck A, Lai G, Belfort MA, Sanz Cortes M, Castillo H. Maternal-fetal surgery for myelomeningocele longitudinal follow-up model: Mitigation of care fragmentation through care coordination and outcomes reporting. J Pediatr Rehabil Med 2025:18758894251331335. [PMID: 40221964 DOI: 10.1177/18758894251331335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2025] Open
Abstract
PurposeFollowing the Global Health Symposium at the Spina Bifida World Congress in 2023, the purpose of this work is to provide a historical overview and a state-of-the-art update on the current global practice of myelomeningocele (MMC) closure and to highlight the importance of care coordination and outcomes reporting to mitigate care fragmentation through a multidisciplinary approach.MethodsPanelists from the Spina Bifida World Congress Global Health Symposium reviewed their institutions' history and experience with risk for fragmentation of care following prenatal repair and proposed solutions to address fragmentation of care.ResultsNew and rapidly evolving in-utero approaches to MMC repair are increasingly accessible for patients worldwide but bring more complexity to follow-up care. There is a consensus that unifying multidisciplinary practices and evaluations across institutions and countries will help make care coordination more comprehensive and longitudinal, and that meeting these standards may decrease care fragmentation.ConclusionRegardless of the open spina bifida repair technique, longitudinal follow-up must be established after fetal surgery, not only for the optimal care of individual patients but also to mitigate care fragmentation, transparently evaluate and compare techniques (for example, through the North American Fetal Therapy Network, the National Spina Bifida Patient Registry, etc.), engage health care professionals, and provide evidence-based multidisciplinary care.
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Affiliation(s)
- Jonathan Castillo
- Developmental Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Mary M Locastro
- Department of Pediatrics, Spina Bifida Center of Central New York, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Romain Corroenne
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - Anjali Malhotra
- Department of Pediatrics, Spina Bifida Center of Central New York, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alexander Van Speybroeck
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Grace Lai
- Department of Neurosurgery, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE, USA
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Magdalena Sanz Cortes
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - Heidi Castillo
- Developmental Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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Ji H, Payette K, Speckert A, Tuura R, Grehten P, Kottke R, Ochseinbein-Kölble N, Hagmann C, Mazzone L, Meuli M, Padden B, Hackenberg A, Wille DA, Moehrlen U, Latal B, SPINA BIFIDA STUDY GROUP ZURICH, Jakab A. Thalamic connectivity topography in newborns with spina bifida: association with neurological functional level but not developmental outcome at 2 years. Cereb Cortex 2024; 34:bhad438. [PMID: 37991274 PMCID: PMC10793566 DOI: 10.1093/cercor/bhad438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 11/23/2023] Open
Abstract
Spina bifida affects spinal cord and cerebral development, leading to motor and cognitive delay. We investigated whether there are associations between thalamocortical connectivity topography, neurological function, and developmental outcomes in open spina bifida. Diffusion tensor MRI was used to assess thalamocortical connectivity in 44 newborns with open spina bifida who underwent prenatal surgical repair. We quantified the volume of clusters formed based on the strongest probabilistic connectivity to the frontal, parietal, and temporal cortex. Developmental outcomes were assessed using the Bayley III Scales, while the functional level of the lesion was assessed by neurological examination at 2 years of age. Higher functional level was associated with smaller thalamo-parietal, while lower functional level was associated with smaller thalamo-temporal connectivity clusters (Bonferroni-corrected P < 0.05). Lower functional levels were associated with weaker thalamic temporal connectivity, particularly in the ventrolateral and ventral anterior nuclei. No associations were found between thalamocortical connectivity and developmental outcomes. Our findings suggest that altered thalamocortical circuitry development in open spina bifida may contribute to impaired lower extremity function, impacting motor function and independent ambulation. We hypothesize that the neurologic function might not merely be caused by the spinal cord lesion, but further impacted by the disruption of cerebral neuronal circuitry.
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Affiliation(s)
- Hui Ji
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Kelly Payette
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Anna Speckert
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University Research Priority Program (URPP), Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zurich, Zurich 8006, Switzerland
| | - Ruth Tuura
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Patrice Grehten
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Raimund Kottke
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Nicole Ochseinbein-Kölble
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Department of Obstetrics, University Hospital of Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
| | - Cornelia Hagmann
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Neonatology, University Children's Hospital Zurich, Zurich 8032, Switzerland
| | - Luca Mazzone
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich 8032, Switzerland
| | - Martin Meuli
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
| | - Beth Padden
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Division of Pediatric Rehabilitation, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - Annette Hackenberg
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
- Department of Pediatric Neurology, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | - David-Alexander Wille
- Department of Pediatric Neurology, Cantonal Hospital of Baden, Baden 5404, Switzerland
| | - Ueli Moehrlen
- Zurich Center for Fetal Diagnosis and Therapy, Zurich 8032, Switzerland
- Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University of Zurich, Zurich 8006, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich 8032, Switzerland
| | - Beatrice Latal
- Children’s Research Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- University Research Priority Program (URPP), Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zurich, Zurich 8006, Switzerland
- University of Zurich, Zurich 8006, Switzerland
- Child Development Center, University Children’s Hospital Zurich, Zurich 8032, Switzerland
| | | | - Andras Jakab
- Center for MR Research, University Children’s Hospital Zurich, Zurich 8032, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich 8006, Switzerland
- University Research Priority Program (URPP), Adaptive Brain Circuits in Development and Learning (AdaBD), University of Zurich, Zurich 8006, Switzerland
- University of Zurich, Zurich 8006, Switzerland
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Nguyen LT, Le HT, Nguyen KT, Bui HT, Nguyen APT, Ngo DV, Hoang DM, Ngo MD. Outcomes of autologous bone marrow mononuclear cell administration in the treatment of neurologic sequelae in children with spina bifida. Stem Cell Res Ther 2023; 14:115. [PMID: 37118832 PMCID: PMC10148418 DOI: 10.1186/s13287-023-03349-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND To evaluate the safety and efficacy of autologous bone marrow mononuclear cell (BMMNC) infusion in the management of neurological sequelae in children with spina bifida (SB). METHODS BMMNCs were harvested from bilateral anterior iliac crests. Two intrathecal BMMNC administrations were performed with an interval of 6 months. The measurements of outcomes included clinical assessments, cystomanometry and rectomanometry. RESULTS Eleven children with SB underwent autologous BMMNC infusions from 2016 to 2020. There were no severe adverse events during the study period. The number of patients requiring assistance to expel stools decreased from 11 before cell infusion to 3 after the second cell infusion. The number of patients who had urine leakage decreased from 9 patients at baseline to 3 patients after the second BMMNC infusion. The mean bladder capacity increased from 127.7 ± 59.2 ml at baseline to 136.3 ± 54.8 ml at six months and to 158.3 ± 56.2 ml at 12 months after BMMNC infusions. Detrusor pressure (pdet) decreased from 32.4 ± 22.0 cm H2O at baseline to 21.9 ± 11.8 cm H2O after 12 months of follow-up. At baseline, six patients could walk independently. After the 2nd infusion, eight patients could walk independently. CONCLUSION Intrathecal infusions of autologous bone marrow mononuclear cells are safe and may improve bowel, bladder, and motor function in children with SB. TRIAL REGISTRATION NCT, NCT05472428. Registered July 25, 2022- Retrospectively registered, https://www. CLINICALTRIALS gov/ct2/show/NCT05472428 .
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Affiliation(s)
- Liem Thanh Nguyen
- Vinmec Research Institute of Stem Cell and Gene Technology, Vinmec Healthcare System, 458 Minh Khai, Hanoi, Vietnam.
- College of Health Science, VinUniversity, Vinhomes Ocean Park, Gia Lam District, Hanoi, Vietnam.
- Vinmec International Hospital - Times City, Vinmec Health Care System, 458 Minh Khai, Hanoi, Vietnam.
| | - Huong Thu Le
- Vinmec International Hospital - Times City, Vinmec Health Care System, 458 Minh Khai, Hanoi, Vietnam
| | - Kien Trung Nguyen
- Vinmec Research Institute of Stem Cell and Gene Technology, Vinmec Healthcare System, 458 Minh Khai, Hanoi, Vietnam
| | - Hang Thi Bui
- Vinmec International Hospital - Times City, Vinmec Health Care System, 458 Minh Khai, Hanoi, Vietnam
| | - Anh Phuong Thi Nguyen
- Vinmec International Hospital - Times City, Vinmec Health Care System, 458 Minh Khai, Hanoi, Vietnam
| | - Doan Van Ngo
- Vinmec International Hospital - Times City, Vinmec Health Care System, 458 Minh Khai, Hanoi, Vietnam
| | - Duc Minh Hoang
- Vinmec Research Institute of Stem Cell and Gene Technology, Vinmec Healthcare System, 458 Minh Khai, Hanoi, Vietnam
| | - Minh Duy Ngo
- Vinmec International Hospital - Times City, Vinmec Health Care System, 458 Minh Khai, Hanoi, Vietnam
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Advances in Fetal Surgical Repair of Open Spina Bifida. Obstet Gynecol 2023; 141:505-521. [PMID: 36735401 DOI: 10.1097/aog.0000000000005074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023]
Abstract
Spina bifida remains a common congenital anomaly of the central nervous system despite national fortification of foods with folic acid, with a prevalence of 2-4 per 10,000 live births. Prenatal screening for the early detection of this condition provides patients with the opportunity to consider various management options during pregnancy. Prenatal repair of open spina bifida, traditionally performed by the open maternal-fetal surgical approach through hysterotomy, has been shown to improve outcomes for the child, including decreased need for cerebrospinal fluid diversion surgery and improved lower neuromotor function. However, the open maternal-fetal surgical approach is associated with relatively increased risk for the patient and the overall pregnancy, as well as future pregnancies. Recent advances in minimally invasive prenatal repair of open spina bifida through fetoscopy have shown similar benefits for the child but relatively improved outcomes for the pregnant patient and future childbearing.
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Sanz Cortes M, Corroenne R, Johnson B, Sangi-Haghpeykar H, Mandy G, VanLoh S, Nassr A, Espinoza J, Donepudi R, Shamshirsaz AA, Whitehead WE, Belfort M. Effect of preoperative low-normal cervical length on perinatal outcome after laparotomy-assisted fetoscopic spina bifida repair. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:74-80. [PMID: 36099454 DOI: 10.1002/uog.26070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To determine if preoperative cervical length in the low-normal range increases the risk of adverse perinatal outcome in patients undergoing fetoscopic spina bifida repair. METHODS This was a retrospective cohort study of patients who underwent fetal spina bifida repair between September 2014 and May 2022 at a single center. Cervical length was measured on transvaginal ultrasound during the week before surgery. Eligibility for laparotomy-assisted fetoscopic spina bifida repair was as per the criteria of the Management of Myelomeningocele Study, although maternal body mass index (BMI) up to 40 kg/m2 was allowed. Laparotomy-assisted fetoscopic spina bifida repair was performed, with carbon dioxide insufflation via two 12-French ports in the exteriorized uterus. All patients received the same peri- and postoperative tocolysis regimen, including magnesium sulfate, nifedipine and indomethacin. Postoperative follow-up ultrasound scans were performed either weekly (< 32 weeks' gestation) or twice a week (≥ 32 weeks). Perinatal outcome was compared between patients with a preoperative cervical length of 25-30 mm vs those with a cervical length > 30 mm. Logistic regression analyses and generalized linear mixed regression analyses were used to predict delivery at less than 30, 34 and 37 weeks' gestation. RESULTS The study included 99 patients with a preoperative cervical length > 30 mm and 12 patients with a cervix 25-30 mm in length. One further case which underwent spina bifida repair was excluded because cervical length was measured > 1 week before surgery. No differences in maternal demographics, gestational age (GA) at surgery, duration of surgery or duration of carbon dioxide uterine insufflation were observed between groups. Cases with low-normal cervical length had an earlier GA at delivery (median (range), 35.2 (25.1-39.7) weeks vs 38.2 (26.0-40.9) weeks; P = 0.01), higher rates of delivery at < 34 weeks (41.7% vs 10.2%; P = 0.01) and < 30 weeks (25.0% vs 1.0%; P < 0.01) and a higher rate of preterm prelabor rupture of membranes (PPROM) (58.3% vs 26.3%; P = 0.04) at an earlier GA (mean ± SD, 29.3 ± 4.0 weeks vs 33.0 ± 2.4 weeks; P = 0.05) compared to those with a normal cervical length. Neonates of cases with low-normal cervical length had a longer stay in the neonatal intensive care unit (20 (7-162) days vs 9 (3-253) days; P = 0.02) and higher rates of respiratory distress syndrome (50.0% vs 14.4%; P < 0.01), sepsis (16.7% vs 1.0%; P = 0.03), necrotizing enterocolitis (16.7% vs 0%; P = 0.01) and retinopathy (33.3% vs 1.0%; P < 0.01). There was an association between preoperative cervical length and risk of delivery at < 30 weeks which was significant only for patients with a maternal BMI < 25 kg/m2 (odds ratio, 0.37 (95% CI, 0.07-0.81); P = 0.02). CONCLUSIONS Low-normal cervical length (25-30 mm) as measured before in-utero laparotomy-assisted fetoscopic spina bifida repair may increase the risk of adverse perinatal outcomes, including PPROM and preterm birth, leading to higher rates of neonatal complications. These data warrant further research and are of critical relevance for clinical teams considering the eligibility of patients for in-utero spina bifida repair. Based on this evidence, patients with a low-normal cervical length should be aware of their increased risk for adverse perinatal outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Sanz Cortes
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - R Corroenne
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics, University Hospital of Angers, Angers, France
| | - B Johnson
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - H Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - G Mandy
- Department of Pediatrics, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - S VanLoh
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - A Nassr
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - J Espinoza
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - R Donepudi
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - W E Whitehead
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
- Department of Neurosurgery, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - M Belfort
- Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
- Department of Neurosurgery, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
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7
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Shobeiri P, Presedo A, Karimi A, Momtazmanesh S, Vosoughi F, Nabian MH. Orthopedic management of myelomeningocele with a multidisciplinary approach: a systematic review of the literature. J Orthop Surg Res 2021; 16:494. [PMID: 34389028 PMCID: PMC8361640 DOI: 10.1186/s13018-021-02643-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Myelomeningocele (MMC) is the most common and severe form of spina bifida and imposes a significant burden on patients and the healthcare system. Recently, the multidisciplinary management of MMC has become popular. Herein, we aimed to review the orthopedic management, outcomes, and complications of the of patients with MMC eyeing a multidisciplinary approach. Methods We searched PubMed and EMBASE to find relevant studies published before August 2020. All studies that included clinical management of MMC patients and published earlier than 2000 were considered for review on the condition that they reported at least one orthopedic intervention and the rate of complications. We excluded review articles, case reports, case series, letters, commentaries, editorials, and conference abstracts. The primary and secondary goals of our review were to report the outcomes and complication rates of multidisciplinary management for MMC patients. Results Twenty-six studies included data for the management of 229,791 patients with MMC and were selected. Sixteen studies reported multidisciplinary management in addition to orthopedic management. From those, 11 (42.31%) included urologic management, 13 (50%) neurosurgical management, 11 (42.31%) neurologic management, and 5 (19.23%) gastrointestinal management. All studies included postnatal operations and related management. No randomized clinical trial was found in our search. Conclusion Orthopedic approaches play a key role in MMC management by alleviating spinal deformities, particularly scoliosis, and hip, foot, and ankle complications. However, the most appropriate management, whether surgical or non-surgical, may vary for different patients, given disease severity and the age of patients. Graphical abstract ![]()
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Affiliation(s)
- Parnian Shobeiri
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ana Presedo
- Department of Pediatric Orthopedics, Hôpital Robert Debre, Paris, France
| | - Amirali Karimi
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sara Momtazmanesh
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Fardis Vosoughi
- Department of Orthopedic and trauma surgery, Shariati Hospital and School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Hossein Nabian
- Department of Orthopedic and trauma surgery, Shariati Hospital and School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran. .,Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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8
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Paslaru FG, Panaitescu AM, Iancu G, Veduta A, Gica N, Paslaru AC, Gheorghiu A, Peltecu G, Gorgan RM. Myelomeningocele Surgery over the 10 Years Following the MOMS Trial: A Systematic Review of Outcomes in Prenatal versus Postnatal Surgical Repair. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:707. [PMID: 34356988 PMCID: PMC8307221 DOI: 10.3390/medicina57070707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 12/04/2022]
Abstract
Background and Objectives: Myelomeningocele is the most severe form of spina bifida, a congenital neural tube defect arising from an incomplete neural tube closure during early development with damage worsening with advancing gestational age. The Management of Myelomeningocele Study (MOMS) Trial proved that surgery performed before 26 weeks of gestation significantly improved the prognosis, significantly changing treatment paradigms. This article aims to provide a review of the changes and updates in spina bifida repair over the 10-year period following the MOMS Trial. Material and methods: We performed a systematic review in the PubMed and Cochrane databases as well as a hand-search of high-impact journals using the reference list of all identified articles, searching for randomized controlled trials and observational studies. Results: We identified 27 articles published between 2011 and 2021 that fulfilled the inclusion criteria and review them in the present study. Conclusions: With growing experience and with the improvement of prenatal open and fetoscopic techniques, the outcome of SB-associated conditions could be improved and the risks to both the mother and the fetus reduced. A continuous follow-up of the treated infants and further randomized trials are essential to study the complications and advantages or disadvantages of any given treatment strategy.
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Affiliation(s)
- Francesca Gabriela Paslaru
- Neurosurgical Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 041915 Bucharest, Romania; (F.G.P.); (A.G.); (R.M.G.)
- Neurosurgery Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Anca Maria Panaitescu
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (G.I.); (A.V.); (N.G.); (G.P.)
- Obstetrics and Gynecology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - George Iancu
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (G.I.); (A.V.); (N.G.); (G.P.)
- Obstetrics and Gynecology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alina Veduta
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (G.I.); (A.V.); (N.G.); (G.P.)
| | - Nicolae Gica
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (G.I.); (A.V.); (N.G.); (G.P.)
- Obstetrics and Gynecology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alexandru Catalin Paslaru
- Physiology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Anamaria Gheorghiu
- Neurosurgical Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 041915 Bucharest, Romania; (F.G.P.); (A.G.); (R.M.G.)
| | - Gheorghe Peltecu
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (G.I.); (A.V.); (N.G.); (G.P.)
- Obstetrics and Gynecology Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Radu Mircea Gorgan
- Neurosurgical Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 041915 Bucharest, Romania; (F.G.P.); (A.G.); (R.M.G.)
- Neurosurgery Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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9
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Jakab A, Payette K, Mazzone L, Schauer S, Muller CO, Kottke R, Ochsenbein-Kölble N, Tuura R, Moehrlen U, Meuli M. Emerging magnetic resonance imaging techniques in open spina bifida in utero. Eur Radiol Exp 2021; 5:23. [PMID: 34136989 PMCID: PMC8209133 DOI: 10.1186/s41747-021-00219-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/01/2021] [Indexed: 11/25/2022] Open
Abstract
Magnetic resonance imaging (MRI) has become an essential diagnostic modality for congenital disorders of the central nervous system. Recent advancements have transformed foetal MRI into a clinically feasible tool, and in an effort to find predictors of clinical outcomes in spinal dysraphism, foetal MRI began to unveil its potential. The purpose of our review is to introduce MRI techniques to experts with diverse backgrounds, who are involved in the management of spina bifida. We introduce advanced foetal MRI postprocessing potentially improving the diagnostic work-up. Importantly, we discuss how postprocessing can lead to a more efficient utilisation of foetal or neonatal MRI data to depict relevant anatomical characteristics. We provide a critical perspective on how structural, diffusion and metabolic MRI are utilised in an endeavour to shed light on the correlates of impaired development. We found that the literature is consistent about the value of MRI in providing morphological cues about hydrocephalus development, hindbrain herniation or outcomes related to shunting and motor functioning. MRI techniques, such as foetal diffusion MRI or diffusion tractography, are still far from clinical use; however, postnatal studies using these methods revealed findings that may reflect early neural correlates of upstream neuronal damage in spinal dysraphism.
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Affiliation(s)
- Andras Jakab
- Center for MR-Research, University Children's Hospital Zürich, Zürich, Switzerland. .,Neuroscience Center Zürich, University of Zürich, Zürich, Switzerland.
| | - Kelly Payette
- Center for MR-Research, University Children's Hospital Zürich, Zürich, Switzerland.,Neuroscience Center Zürich, University of Zürich, Zürich, Switzerland
| | - Luca Mazzone
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zürich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland
| | - Sonja Schauer
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zürich, Switzerland
| | | | - Raimund Kottke
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Ruth Tuura
- Center for MR-Research, University Children's Hospital Zürich, Zürich, Switzerland
| | - Ueli Moehrlen
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zürich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland.,University of Zurich, Zürich, Switzerland
| | - Martin Meuli
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zürich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland.,University of Zurich, Zürich, Switzerland
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10
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Gotha L, Pruthi V, Abbasi N, Kulkarni AV, Church P, Drake JM, Carvalho JCA, Diambomba Y, Thakur V, Ryan G, Van Mieghem T. Fetal spina bifida: What we tell the parents. Prenat Diagn 2020; 40:1499-1507. [PMID: 32692418 DOI: 10.1002/pd.5802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/08/2020] [Accepted: 07/19/2020] [Indexed: 12/20/2022]
Abstract
Worldwide, about 150 000 infants are born with spina bifida yearly, making this condition one of the most common fetal central nervous system anomalies compatible with life. Over the last decade, major changes have been introduced in the prenatal diagnosis and management of spina bifida. In this review, we provide a brief summary of the current management of fetal spina bifida and present essential information that should be provided to expecting parents when their fetus has been diagnosed with spina bifida. This information is focused around common parental questions, as encountered in our typical clinical practice, to facilitate knowledge translation.
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Affiliation(s)
- Lara Gotha
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Vagisha Pruthi
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.,Ontario Fetal Centre, Toronto, Canada
| | - Nimrah Abbasi
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.,Ontario Fetal Centre, Toronto, Canada
| | - Abhaya V Kulkarni
- Ontario Fetal Centre, Toronto, Canada.,Division of Neurosurgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paige Church
- Department of Pediatrics, Sunnybrook Health Sciences Centre, Holland-Bloorview Kids Rehabilitation Hospital and University of Toronto, Toronto, Canada
| | - James M Drake
- Ontario Fetal Centre, Toronto, Canada.,Division of Neurosurgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Jose C A Carvalho
- Ontario Fetal Centre, Toronto, Canada.,Department of Anesthesia, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Yenge Diambomba
- Ontario Fetal Centre, Toronto, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Varsha Thakur
- Ontario Fetal Centre, Toronto, Canada.,Department of Cardiology, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Greg Ryan
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.,Ontario Fetal Centre, Toronto, Canada
| | - Tim Van Mieghem
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.,Ontario Fetal Centre, Toronto, Canada
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11
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Altoukhi S, Whitehead CL, Ryan G, Deprest J, Joyeux L, Gallagher K, Drake J, Church P, Horn D, Diambomba Y, Carvalho JCA, Van Mieghem T. Development of a Core outcome set for fetal Myelomeningocele (COSMiC): study protocol. Trials 2020; 21:732. [PMID: 32825852 PMCID: PMC7441650 DOI: 10.1186/s13063-020-04668-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Open spina bifida (OSB) is one of the most common congenital central nervous system defects and leads to long-term physical and cognitive disabilities. Open fetal surgery for OSB improves neurological outcomes and reduces the need for ventriculoperitoneal shunting, compared to postnatal surgery, but is associated with a significant risk of prematurity and maternal morbidity. Fetoscopic surgery comes with less maternal morbidity, yet the question remains whether the procedure is neuroprotective and reduces prematurity. Comparison of outcomes between different treatment options is challenging due to inconsistent outcome reporting. We aim to develop and disseminate a core outcome set (COS) for fetal OSB, to ensure that outcomes relevant to all stakeholders are collected and reported in a standardised fashion in future studies. METHODS The COS will be developed using a validated Delphi methodology. A systematic literature review will be performed to identify outcomes previously reported for prenatally diagnosed OSB. We will assess maternal (primary and subsequent pregnancies), fetal, neonatal and childhood outcomes until adolescence. In a second phase, we will conduct semi-structured interviews with stakeholders, to ensure representation of additional relevant outcomes that may not have been reported in the literature. We will include patients and parents, as well as health professionals involved in the care of these pregnancies and children (fetal medicine specialists, fetal surgeons, neonatologists/paediatricians and allied health). Subsequently, an international group of key stakeholders will rate the importance of the identified outcomes using three sequential online rounds of a modified Delphi Survey. Final agreement on outcomes to be included in the COS, their definition and measurement will be achieved through a face-to-face consensus meeting with all stakeholder groups. Dissemination of the final COS will be ensured through different media and relevant societies. DISCUSSION Development and implementation of a COS for fetal OSB will ensure consistent outcome reporting in future clinical trials, systematic reviews and clinical practice guidelines. This will lead to higher quality research, better evidence-based clinical practice and ultimately improved maternal, fetal and long-term childhood outcomes. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42018104880 . Registered on December 5, 2018. Core Outcome Measures in Effectiveness Trials (COMET): 1187.
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Affiliation(s)
- Samar Altoukhi
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, Canada.,Department of Obstetrics and Gynaecology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Clare L Whitehead
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, Canada.,Department of Obstetrics & Gynaecology, University of Adelaide, Adelaide, Australia.,Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Australia
| | - Greg Ryan
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, Canada.,Ontario Fetal Centre, Mount Sinai Hospital, Toronto, Canada
| | - Jan Deprest
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Institute of Obstetrics and Gynaecology, Women's Health, University College London, London, UK
| | - Luc Joyeux
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Katie Gallagher
- Institute of Child Health, University College London, London, UK
| | - James Drake
- Ontario Fetal Centre, Mount Sinai Hospital, Toronto, Canada.,Department of Neurosurgery, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paige Church
- Department of Neonatology, Holland-Bloorview, Sunnybrook Health Centre and University of Toronto, Toronto, Canada
| | - Daphne Horn
- Department of Medical Informatics, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Yenge Diambomba
- Ontario Fetal Centre, Mount Sinai Hospital, Toronto, Canada.,Department of Neonatology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Jose C A Carvalho
- Ontario Fetal Centre, Mount Sinai Hospital, Toronto, Canada.,Department of Anaesthesia, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Tim Van Mieghem
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, Canada. .,Ontario Fetal Centre, Mount Sinai Hospital, Toronto, Canada.
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