Reduced hindbrain herniation after intrauterine myelomeningocele repair: Areport of four cases

Background: It has been theorized that fetal myelomeningocele repair may re duce ongoing intrauterine injury and perhaps allow healing and regeneration of dysplastic neural tissue. We report on the postnatal imaging studies of the first 4 patients to have undergone intrauterine myelomeningocele repai r at our institution. Methods: Each of the 4 patients underwent postnatal s onographic and MRI. In addition, the postnatal ultrasounds of these 4 were compared to a group of retrospective controls. Results: MRI scans of the 4 experimental subjects revealed no evidence of hindbrain herniation while ot her stigmata of the Chiari-II malformation persisted. In comparison to the retrospective controls this absence of herniation was distinctly unusual. C onclusion: Intrauterine myelomeningocele repair may reduce the degree of hi ndbrain herniation normally seen in patients with myelomeningocele. This ra ises the possibility that intrauterine repair may decrease the morbidity as sociated with the Chiari type-II malformation including brainstem dysfuncti on, hydrocephalus and syringomyelia.