الفهرس 
MeningeomyloceleOnly 14 pages are availabe for public view
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Abstract
Myelomeningocele (MMC), one of the most common congenital malformations, can result in severe lifelong disabilities, including paraplegia, hydrocephalus, Arnold-Chiari II malformation, incontinence, sexual dysfunction, skeletal deformations, and mental impairment. MMC was the first nonlethal anomaly to be treated by fetal surgery. Studies in animals provide compelling evidence that the primary cause of the neurological deficit associated with MMC is not simply incomplete neurulation but rather chronic mechanical injury and amniotic-fluid-induced chemical trauma that progressively damage the exposed neural tissue during gestation. Initial results suggest that the surgical repair of MMC before 25 weeks of gestation may preserve neurological function, reverse the hindbrain herniation of the Arnold-Chiari II malformation, and obviate the need for postnatal placement of a ventriculoperitoneal shunt.
Until recently, fetal surgical interventions have been limited to fetal anomalies perceived to be lethal because of the potential risk of such a major surgical procedure to an otherwise healthy mother. Fetal surgery for MMC – a nonlethal but highly morbid disorder – has extended the original criteria for fetal surgery to a disorder causing irreversible organ damage before birth with associated quality-of-life morbidities after birth. We have traveled a long road in our effort to improve the outcome of MMC fetuses. The idea of reducing or preventing the significant MMC-associated neurological morbidities by fetal surgery was born over 20 years ago and was followed by many years of experimental studies in multiple animal models to demonstrate the potential benefit and feasibility of such intervention. The initial clinical efforts succeeded based on careful and cautious application in a highly selected patient cohort and were recently confirmed in a properly controlled randomized clinical trial which has provided a definitive answer regarding the efficacy of fetal MMC surgery. Despite the success, possible fetal benefits must be balanced against the risks of fetal MMC surgery, continued follow-up is imperative to determine whether the early benefits are durable and to evaluate the impact of fetal MMC surgery on future bowel and bladder continence, sexual function and mental capacity.