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01-07-2017 | Focus Session

New directions in fetal surgery for myelomeningocele

Authors: Sandra K. Kabagambe, Y. Julia Chen, Melissa A. Vanover, Payam Saadai, Diana L. Farmer

Published in: Child's Nervous System | Issue 7/2017

Abstract

The treatment of children with myelomeningocele (MMC) has improved over time, from supportive management to early postnatal closure to prenatal repair of the defect. The Management of Myelomeningocele Study (MOMS) showed that prenatal repair of MMC resulted in improved neurological outcomes compared to postnatal closure. Follow-up studies showed that prenatal repair was, as with any other fetal intervention, associated with higher rates of obstetrical complications. There was no significant difference in urological outcomes. Long-term follow-up of ambulatory status, executive functioning, and urological outcomes is needed to determine the durable effects of fetal MMC repair on mobility, functional independence, and the prevalence of renal insufficiency in patients with MMC who survive to adulthood. The future of fetal MMC repair consists of developing strategies to reduce maternal morbidity and improve infant outcomes. Fetoscopic MMC repair has been suggested as an alternative to open repair that may reduce obstetrical complications and the need for cesarean delivery in subsequent pregnancies. Translational research using mesenchymal stromal cells to augment fetal repair of ovine MMC has shown improvement in motor function.

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Title: New directions in fetal surgery for myelomeningocele
Authors: Sandra K. Kabagambe
Y. Julia Chen
Melissa A. Vanover
Payam Saadai
Diana L. Farmer
Publication date: 01-07-2017
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 7/2017
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-017-3438-6

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