Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Child's Nervous System
Published in: Child's Nervous System 11/2020

01-11-2020 | Hydrocephalus | Original Article

Alterations in skull base anatomy in intrauterine and postnatal repaired myelomeningoceles

Authors: Marcos Devanir Silva da Costa, Jardel Mendonça Nicacio, Patricia Alessandra Dastoli, Italo Capraro Suriano, Stéphanno Gomes Pereira Sarmento, Mauricio Mendes Barbosa, Antonio Fernandes Moron, Sergio Cavalheiro

Published in: Child's Nervous System | Issue 11/2020

Login to get access

Abstract

Purpose

The aim of this study was to analyze the skull base anatomy of patients who underwent intrauterine or postnatal myelomeningocele repair and to determine its relationship with hydrocephalus.

Methods

This was a retrospective cross-sectional study that analyzed three groups: the postnatal group, 57 patients who underwent myelomeningocele repair up to 48 h after birth; the fetal group, 70 patients who underwent myelomeningocele repair between 19 and 27 weeks of gestation; and a control group (65). We compared the rate of hydrocephalus treatment, the clivus-supraocciput angle (CSA), and the Welcher angle.

Results

The mean CSA in the fetal group was 87.6°, and the postnatal group was significantly different at 78.3° (p < 0.0001). The control group (89.1°) was significantly different from the postnatal group but not from the fetal group. The mean Welcher angle was not significantly different between the groups. There was an 8.5% rate of surgical treatment for hydrocephalus in the fetal group, compared with 73.6% in the postnatal group.

Conclusions

The CSA in the fetal group was larger than that in the postnatal group, which may explain the decrease in the prevalence of hydrocephalus in the fetal group.
Literature
1.
Gynecologists ACoOa (1986) Prenatal detection of neural tube defects. Technical bulletin n° 99
2.
Manning SM, Jennings R, Madsen JR (2000) Pathophysiology, prevention, and potential treatment of neural tube defects. Ment Retard Dev Disabil Res Rev 6:6–14CrossRef
3.
Northrup H, Volcik KA (2000) Spina bifida and other neural tube defects. Curr Probl Pediatr 30:313–332PubMed
4.
Cragan JD, Roberts HE, Edmonds LD, Khoury MJ, Kirby RS, Shaw GM, Velie EM, Merz RD, Forrester MB, Williamson RA, Krishnamurti DS, Stevenson RE, Dean JH (1995) Surveillance for anencephaly and spina bifida and the impact of prenatal diagnosis--United States, 1985-1994. MMWR CDC Surveill Summ 44:1–13PubMed
5.
Adzick NS, Thom EA, Spong CY, Brock JW 3rd, Burrows PK, Johnson MP, Howell LJ, Farrell JA, Dabrowiak ME, Sutton LN, Gupta N, Tulipan NB, D'Alton ME, Farmer DL, Investigators M (2011) A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 364:993–1004CrossRef
6.
Cavalheiro S, da Costa M, Moron A, Leonard J (2017) Comparison of prenatal and postnatal management of patients with myelomeningocele. Neurosurg Clin N Am 28
7.
Tulipan N, Wellons JC 3rd, Thom EA, Gupta N, Sutton LN, Burrows PK, Farmer D, Walsh W, Johnson MP, Rand L, Tolivaisa S, D'Alton ME, Adzick NS, Investigators M (2015) Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement. J Neurosurg Pediatr 16:613–620CrossRef
8.
Bruner JP, Tulipan N, Paschall RL, Boehm FH, Walsh WF, Silva SR, Hernanz-Schulman M, Lowe LH, Reed GW (1999) Fetal surgery for myelomeningocele and the incidence of shunt-dependent hydrocephalus. JAMA 282:1819–1825CrossRef
9.
Bruner JP, Tulipan NE, Richards WO (1997) Endoscopic coverage of fetal open myelomeningocele in utero. Am J Obstet Gynecol 176:256–257CrossRef
10.
Meuli M, Meuli-Simmen C, Yingling CD, Hutchins GM, Hoffman KM, Harrison MR, Adzick NS (1995) Creation of myelomeningocele in utero: a model of functional damage from spinal cord exposure in fetal sheep. J Pediatr Surg 30:1028–1032 discussion 1032-1023CrossRef
11.
Michejda M (1984) Intrauterine treatment of spina bifida: primate model. Z Kinderchir 39:259–261PubMed
12.
Cavalheiro S, da Costa MDS, Mendonca JN, Dastoli PA, Suriano IC, Barbosa MM, Moron AF (2017) Antenatal management of fetal neurosurgical diseases. Childs Nerv Syst 33:1125–1141CrossRef
13.
Moron AF, Barbosa MM, Milani H, Sarmento SG, Santana E, Suriano IC, Dastoli PA, Cavalheiro S (2018) Perinatal outcomes after open fetal surgery for myelomeningocele repair: a retrospective cohort study. BJOG 125:1280–1286CrossRef
14.
D'Addario V, Pinto V, Del Bianco A, Di Naro E, Tartagni M, Miniello G, Serio G (2001) The clivus-supraocciput angle: a useful measurement to evaluate the shape and size of the fetal posterior fossa and to diagnose Chiari II malformation. Ultrasound Obstet Gynecol 18:146–149CrossRef
15.
Woitek R, Dvorak A, Weber M, Seidl R, Bettelheim D, Schopf V, Amann G, Brugger PC, Furtner J, Asenbaum U, Prayer D, Kasprian G (2014) MR-based morphometry of the posterior fossa in fetuses with neural tube defects of the spine. PLoS One 9:e112585CrossRef
16.
Smoker WR (1994) Craniovertebral junction: normal anatomy, craniometry, and congenital anomalies. Radiographics 14:255–277CrossRef
17.
Grant RA, Heuer GG, Carrion GM, Adzick NS, Schwartz ES, Stein SC, Storm PB, Sutton LN (2011) Morphometric analysis of posterior fossa after in utero myelomeningocele repair. J Neurosurg Pediatr 7:362–368CrossRef
18.
Barreto EQS, Cavalheiro S, Milani HJF, Barbosa MM, Araujo Junior E, Nardozza LMM, Moron AF (2018) Cerebellar herniation demonstrated by the occipitum-dens line: ultrasonography assessment of normal fetuses, fetuses with myelomeningocele, and fetuses that underwent antenatal myelomeningocele surgery. Prenat Diagn 38:280–285CrossRef
19.
Sutton LN, Adzick NS, Bilaniuk LT, Johnson MP, Crombleholme TM, Flake AW (1999) Improvement in hindbrain herniation demonstrated by serial fetal magnetic resonance imaging following fetal surgery for myelomeningocele. JAMA 282:1826–1831CrossRef
20.
McLone DG, Knepper PA (1989) The cause of Chiari II malformation: a unified theory. Pediatr Neurosci 15:1–12CrossRef
21.
Bernard S, Loukas M, Rizk E, Oskouian RJ, Delashaw J, Tubbs RS (2015) The human occipital bone: review and update on its embryology and molecular development. Childs Nerv Syst 31:2217–2223CrossRef
22.
Matsumura G, England MA, Uchiumi T, Kodama G (1994) The fusion of ossification centres in the cartilaginous and membranous parts of the occipital squama in human fetuses. J Anat 185(Pt 2):295–300PubMedPubMedCentral
23.
Protzenko T, Bellas A, Pousa MS, Protzenko M, Fontes JM, de Lima Silveira AM, Sa CA, Pereira JP, Salomao RM, Salomao JFM, Dos Santos Gomes SC (2019) Reviewing the prognostic factors in myelomeningocele. Neurosurg Focus 47:E2CrossRef
Metadata
Title
Alterations in skull base anatomy in intrauterine and postnatal repaired myelomeningoceles
Authors
Marcos Devanir Silva da Costa
Jardel Mendonça Nicacio
Patricia Alessandra Dastoli
Italo Capraro Suriano
Stéphanno Gomes Pereira Sarmento
Mauricio Mendes Barbosa
Antonio Fernandes Moron
Sergio Cavalheiro
Publication date
01-11-2020
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 11/2020
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-020-04587-6

Other articles of this Issue 11/2020

Child's Nervous System 11/2020 Go to the issue

Original Article

ETV in infancy and childhood below 2 years of age for treatment of hydrocephalus

Case Report

Endonasal endoscopic management of the craniopharyngeal canal meningoencephalocele using a nasoseptal flap in a 6-month-old infant

Original Article

Proatlas anomalies in craniofacial malformations: 5-year experience in King Chulalongkorn Memorial Hospital

Original Article

Validating the management paradigm for pediatric spinal aneurysmal bone cysts to optimize long-term outcomes: an institutional experience

Original Article

The results of decompression of the musculocutaneous nerve entrapment in children with obstetric brachial plexus palsy

Original Article

Management of multiloculated hydrocephalus in children with emphasis on role of CT ventriculography