Beuriat Pierre-Aurelien, Poirot Isabelle, Hameury Frederic, Demede Delphine, Sweeney Kieron J, Szathmari Alexandru, Di Rocco Federico, Mottolese Carmine
Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677, Lyon Cedex, France.
Department of Pediatric Rehabilitation l'ESCALE, Hôpital Femme Mère Enfant, 32 Avenue du Doyen Jean Lépine, 69677, Lyon Cedex, France.
Childs Nerv Syst. 2019 Jun;35(6):957-963. doi: 10.1007/s00381-019-04123-1. Epub 2019 Mar 27.
Postnatal closure of a myelomeningocele remains the standard of care in many countries. The prenatal closure has given hope for decreasing the damage to the neural placode and has challenged classic management. However, this technique presents potential sources of complications. Patients with MMC with an anatomical level of L4 and below have a better functional prognosis than higher level malformations. Are they still candidates for prenatal surgery?
To evaluate outcome of MMC with an anatomical level of L4 and below and discuss, with support of the literature, the indications to perform prenatal closure in this particular group of patients.
Twenty-nine children were included in this observational study. The level of the vertebral malformation was sacral in 12 cases (41.4%) or lumbar (level ≤ L4) in 17 cases (58.6%). All the patients was operated postnatally for closure of the MMC with microsurgical technique as soon as possible after clinical evaluation (range 0-97 days).
Only 11 out of 29 patients (37.9%) needed of a CSF diversion. A Chiari II malformation was present before MMC closure in 17 patients (58.6%) and only in 5 (17%) after. Twenty-six patients (89.7%) were able to walk. Seven (23%) and 16 (55%) of our patients have a normal bladder and bowel control, respectively. All school-aged children attend school.
The functional outcome for low-level MMC is good when managed with modern microneurosurgical techniques with a low risk for the patient and the mother. Therefore, we do not suggest prenatal surgery for subgroup of infant with MM.
在许多国家，脊髓脊膜膨出的产后闭合仍是标准治疗方法。产前闭合为减少对神经基板的损伤带来了希望，并对传统治疗方法提出了挑战。然而，这项技术存在潜在的并发症来源。解剖学水平在L4及以下的脊髓脊膜膨出患者比更高水平畸形的患者具有更好的功能预后。他们仍然是产前手术的候选者吗？
评估解剖学水平在L4及以下的脊髓脊膜膨出的治疗结果，并在文献支持下讨论对这一特定患者群体进行产前闭合的适应症。
29名儿童纳入了这项观察性研究。椎体畸形水平为骶骨的有12例（41.4%），腰椎（水平≤L4）的有17例（58.6%）。所有患者在临床评估后尽快采用显微外科技术进行产后脊髓脊膜膨出闭合手术（范围为0 - 97天）。
29例患者中只有11例（37.9%）需要脑脊液分流。17例患者（58.6%）在脊髓脊膜膨出闭合前存在Chiari II畸形，闭合后仅5例（17%）存在。26例患者（89.7%）能够行走。我们的患者中分别有7例（23%）和16例（55%）膀胱和肠道控制正常。所有学龄儿童都上学。
采用现代显微神经外科技术治疗低位脊髓脊膜膨出时，功能预后良好，对患者和母亲的风险较低。因此，我们不建议对脊髓脊膜膨出婴儿亚组进行产前手术。
