Fetal surgery for myelomeningocele and the incidence of shunt-dependent hydrocephalus
Fetal surgery for myelomeningocele and the incidence of shunt-dependent hydrocephalus
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DOI：
10.1001/jama.282.19.1819
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发表时间：
1999-11-17
影响因子：
120.7
通讯作者：
Reed, GW
中科院分区：
文献类型：
--
作者：
Bruner, JP;Tulipan, N;Reed, GW
子宫内缝合暴露的脊髓组织可防止手术造成脊髓缺损的动物继发性神经损伤;然而，子宫内脊髓脊膜膨出修复术是否能改善脊柱裂婴儿的神经功能预后尚不清楚。目的：确定子宫内脊髓脊膜膨出修复术与标准治疗相比是否能改善患者的预后。在1990年1月和1999年2月之间进行了一项非随机观察性研究。设置三级保健医疗中心。参与者29名研究患者的样本与孤立的胎儿脊髓脊膜膨出提到宫内修复，这是在24和30孕周和23对照组与病例的诊断、病变程度、实践参数和日历时间相匹配。所有婴儿在分娩后随访至少6个月。主要结果测量脑室腹腔分流术的要求、产科并发症、分娩时的胎龄和出生体重，研究组与对照组比较。结果研究婴儿中脑室腹腔分流术减压的要求显著降低（59%比91%，P = 0.01）。研究婴儿中分流术放置时的中位年龄也较大（50 vs 5天; P =.006）。这可能是由于研究婴儿中后脑疝的发生率降低（38%对95%; P
Context Intrauterine closure of exposed spinal cord tissue prevents secondary neurologic injury in animals with a surgically created spinal defect; however, whether in utero repair of myelomeningocele improves neurologic outcome in infants with spina bifida is not known.Objective To determine whether intrauterine repair of myelomeningocele improves patient outcomes compared with standard care.Design Single-institution, nonrandomized observational study conducted between January 1990 and February 1999.Setting Tertiary care medical center.Participants A sample of 29 study patients with isolated fetal myelomeningocele referred for intrauterine repair that was performed between 24 and 30 gestational weeks and 23 controls matched to cases for diagnosis, level of lesion, practice parameters, and calendar time. All infants were followed up for a minimum of 6 months after delivery.Main Outcome Measures Requirement for ventriculoperitoneal shunt placement, obstetrical complications, gestational age at delivery, and birth weight for study vs control subjects.Results The requirement for ventriculoperitoneal shunt placement for decompression of hydrocephalus was significantly decreased among study infants (59% vs 91%, P =.01). The median age at shunt placement was also older among study infants (50 vs 5 days; P =.006). This may be explained by the reduced incidence of hindbrain herniation among study infants (38% vs 95%; P