open access

Vol 88, No 1 (2017)
Review paper
Published online: 2017-01-31
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Current views on fetal surgical treatment of myelomeningocele — the Management of Myelomeningocele Study (MOMS) trial and Polish clinical experience

Jacek Zamłyński, Ewa Horzelska, Mateusz Zamłyński, Katarzyna Olszak-Wąsik, Leszek Nowak, Piotr Bodzek, Tomasz Horzelski, Rafał Bablok, Anita Olejek
DOI: 10.5603/GP.a2017.0006
·
Pubmed: 28157255
·
Ginekol Pol 2017;88(1):31-35.

open access

Vol 88, No 1 (2017)
REVIEW PAPERS Obstetrics
Published online: 2017-01-31

Abstract

Abstract

Myelomeningocele (MMC) is the most frequent congenital defect of the central nervous system for which there is no satisfactory alternative to postnatal treatment. On the contrary prenatal MMC surgery is conducting before birth and is aimed at protecting from Chiari II malformation. The main goal of fetal MMC repair is to improve development and life quality of children with Chiari II malformation. Management of Myelomeningocele Study (MOMS) which was published in 2011 clearly confirmed effectiveness of prenatal surgery. In this paper we compare MOMS results with our own clinical experience. Thanks to high effectiveness and significant improvement in safety of maternal-fetal surgery prenatal MMC surgery become a new standard of treatment.

Abstract

Abstract

Myelomeningocele (MMC) is the most frequent congenital defect of the central nervous system for which there is no satisfactory alternative to postnatal treatment. On the contrary prenatal MMC surgery is conducting before birth and is aimed at protecting from Chiari II malformation. The main goal of fetal MMC repair is to improve development and life quality of children with Chiari II malformation. Management of Myelomeningocele Study (MOMS) which was published in 2011 clearly confirmed effectiveness of prenatal surgery. In this paper we compare MOMS results with our own clinical experience. Thanks to high effectiveness and significant improvement in safety of maternal-fetal surgery prenatal MMC surgery become a new standard of treatment.

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Keywords

operacje wewnątrzmaciczne; rozszczep kręgosłupa; przepuklina oponowo-rdzeniowa; zespół Chari II

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About this article
Title

Current views on fetal surgical treatment of myelomeningocele — the Management of Myelomeningocele Study (MOMS) trial and Polish clinical experience

Journal

Ginekologia Polska

Issue

Vol 88, No 1 (2017)

Article type

Review paper

Pages

31-35

Published online

2017-01-31

DOI

10.5603/GP.a2017.0006

Pubmed

28157255

Bibliographic record

Ginekol Pol 2017;88(1):31-35.

Keywords

operacje wewnątrzmaciczne
rozszczep kręgosłupa
przepuklina oponowo-rdzeniowa
zespół Chari II

Authors

Jacek Zamłyński
Ewa Horzelska
Mateusz Zamłyński
Katarzyna Olszak-Wąsik
Leszek Nowak
Piotr Bodzek
Tomasz Horzelski
Rafał Bablok
Anita Olejek

References (35)
  1. Timbolschi D, Schaefer E, Monga B, et al. Neural tube defects: the experience of the registry of congenital malformations of Alsace, France, 1995-2009. Fetal. Diagn. Ther. 2015; 37(1): 6–17.
  2. Boulet SL, Yang Q, Mai C, et al. National Birth Defects Prevention Network. Trends in the postfortification prevalence of spina bifida and anencephaly in the United States. Birth Defects Res. Part A Clin. Mol. Teratol. 2008; 82(7): 527–532.
  3. • LaB, Materna-Kiryluk A, Badura-Stronka M, et al. Wrodzone wady rozwojowe w Polsce. Zespół Polskiego Rejestru Wrodzonych Wad Rozwojowych, Pozna. ; 2010.
  4. Seremak-Mrozikiewicz A. [The significance of folate metabolism in complications of pregnant women]. Ginekol. Pol. 2013; 84(5): 377–384.
  5. Juranek J, Salman MS. Anomalous development of brain structure and function in spina bifida myelomeningocele. Dev Disabil Res Rev. 2010; 16(1): 23–30.
  6. Danzer E, Johnson MP. Fetal surgery for neural tube defects. Semin Fetal Neonatal Med. 2014; 19(1): 2–8.
  7. Lam S, Harris D, Rocque BG, et al. Pediatric endoscopic third ventriculostomy: a population-based study. J Neurosurg Pediatr. 2014; 14(5): 455–464.
  8. Maher CO, Goumnerova L, Madsen JR, et al. Outcome following multiple repeated spinal cord untethering operations. J. Neurosurg. 2007; 106(6 Suppl): 434–438.
  9. • Bo, Sawicka E, Piwowar W. Przepuklina oponowo-rdzeniowa - jak zmieniło sie postępowanie podczas pierwszego etapu leczenia chirurgicznego wady. Ocena dwóch grup pacjentów leczonych w latach 1986-1992 oraz 1999-2005. Med Wieku Rozwoj. 2009; 13: 260–269.
  10. Thompson DNP. Postnatal management and outcome for neural tube defects including spina bifida and encephalocoeles. Prenat. Diagn. 2009; 29(4): 412–419.
  11. Adzick NS. Fetal myelomeningocele: natural history, pathophysiology, and in-utero intervention. Semin Fetal Neonatal Med. 2010; 15(1): 9–14.
  12. Heffez DS, Aryanpur J, Hutchins GM, et al. The paralysis associated with myelomeningocele. Neurosurgery. 1990: 987.
  13. Meuli M, Moehrlen U. Fetal surgery for myelomeningocele is effective: a critical look at the whys. Pediatr. Surg. Int. 2014; 30(7): 689–697.
  14. Shen J, Zhou G, Chen H, et al. Morphology of nervous lesion in the spinal cord and bladder of fetal rats with myelomeningocele at different gestational age. J. Pediatr. Surg. 2013; 48(12): 2446–2452.
  15. Paek BW, Farmer DL, Wilkinson CC, et al. Hindbrain herniation develops in surgically created myelomeningocele but is absent after repair in fetal lambs. Am. J. Obstet. Gynecol. 2000; 183(5): 1119–1123.
  16. Tulipan N, Bruner JP. Myelomeningocele repair in utero: a report of three cases. Pediatr Neurosurg. 1998; 28(4): 177–180.
  17. Adzick N, Sutton L, Crombleholme T, et al. Successful fetal surgery for spina bifida. The Lancet. 1998; 352(9141): 1675–1676.
  18. Danzer E, Finkel RS, Rintoul NE, et al. Reversal of hindbrain herniation after maternal-fetal surgery for myelomeningocele subsequently impacts on brain stem function. Neuropediatrics. 2008; 39(6): 359–362.
  19. Danzer E, Gerdes M, Bebbington MW, et al. Lower extremity neuromotor function and short-term ambulatory potential following in utero myelomeningocele surgery. Fetal. Diagn. Ther. 2009; 25(1): 47–53.
  20. Adzick NS, Thom EA, Spong CY, et al. MOMS Investigators. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N. Engl. J. Med. 2011; 364(11): 993–1004.
  21. Carr MC. Urological results after fetal myelomeningocele repair in pre-MOMS trial patients at the Children's Hospital of Philadelphia. Fetal. Diagn. Ther. 2015; 37(3): 211–218.
  22. • Danzer E, Gerdes M, Bebbington MW, Zarnow DM, Adzick NS, Johnson MP. Preschool neurodevelopmental outcome of children following fetal myelomeningocele closure. Am J Obstet Gynecol 2010; 202: 1-9.
  23. • Danzer E, Thomas NH, Sullivan A, [et al.]. Long-term neurofunctional outcome, executive functioning, and behavioral adaptive skills following fetal myelomeningocele surgery. Am J Obstet Gynecol 2013; 208: 183.
  24. • Sr, Świątkowska-Freund M, Gołębiewski A, et al. Chirurgia prenatalna: przyszłość czy ślepy zaułek : doświadczenia wstępne. Przegl Pediatr. 2007; 37: 7–9.
  25. Zamłyńiski J, Olejek A, Bohosiewicz J, et al. [Perinatal results of intrauterine open fetal surgery of fetuses diagnosed with myelomeningocoele--the clinical report of ten cases]. Ginekol. Pol. 2007; 78(8): 647–651.
  26. • Za, Olejek A, Bohosiewicz J, et al. Kliniczne aspekty chirurgicznego zamknięcia przepukliny oponowo-rdzeniowej płodu z zespołem Chiari II. Perinatologia, Neonatologia i Ginekologia. 2010; 3: 41–47.
  27. • Bo, Koszutski T, Kowalik J, et al. Fetal repair of myelomeningocele in human fetuses. Experience related with 33 cases. Archives of Perinatal Medicine. 2011; 17: 81–84.
  28. Zamłyński J, Olejek A, Koszutski T, et al. Comparison of prenatal and postnatal treatments of spina bifida in Poland--a non-randomized, single-center study. J. Matern. Fetal. Neonatal. Med. 2014; 27(14): 1409–1417.
  29. • Olejek A, Zamłyński M, Olszak-Wąsik K, [et al.]. Prenatal evolution of Chiari II malformation after intrauterine fetal MMC repair. Patients selection, maternal, fetal and neonatal results. Indian J Appl Res 2015; 5: 60-63.
  30. Bennett KA, Carroll MA, Shannon CN, et al. Reducing perinatal complications and preterm delivery for patients undergoing in utero closure of fetal myelomeningocele: further modifications to the multidisciplinary surgical technique. J Neurosurg Pediatr. 2014; 14(1): 108–114.
  31. Heuer GG, Adzick NS, Sutton LN. Fetal myelomeningocele closure: technical considerations. Fetal. Diagn. Ther. 2015; 37(3): 166–171.
  32. American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 550: maternal-fetal surgery for myelomeningocele. Obstet Gynecol. 2013; 121(1): 218–219.
  33. Wilson RD, Wilson RD, Audibert F, et al. SOGC Genetics Committee, Special Contributors, Society of Obstetricians and Gynaecologists of Canada. Prenatal screening, diagnosis, and pregnancy management of fetal neural tube defects. J Obstet Gynaecol Can. 2014; 36(10): 927–942.
  34. Cohen AR, Couto J, Cummings JJ, et al. MMC Maternal-Fetal Management Task Force. Position statement on fetal myelomeningocele repair. Am. J. Obstet. Gynecol. 2014; 210(2): 107–111.
  35. • Ol, Bohosiewicz J, Chilarski A, et al. Rozszczep kręgosłupa (spina bifida). Przepuklina oponowa-rdzeniowa (myelomeningocele). Rekomendacje Polskiego Towarzystwa Ginekologicznego. Ginekol Dypl. 2006; 8: 122–124.

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