MYELOMENINGOCELE REPAIR IN-UTERO - A REPORT OF 3 CASES

Background: Evidence accumulating over the last 10 years suggests that the exposed spinal cord tissue in a myelomeningocele sustains a secon dary injury as the result of prolonged exposure to the intrauterine en vironment. These data suggest that early closure of the myelomeningoce le sac might prevent such injury and in turn improve the neurologic ou tcome in the affected infant. Methods: Three patients with fetuses car rying the ultrasonic diagnosis of myelomeningocele elected to enter a study of the feasibility of repairing myelomeningocele in utero, At ap proximately 28 weeks of gestation each patient underwent laparotomy an d hysterotomy, thus exposing the myelomeningocele defect. The defect w as closed in a routine surgical fashion, and the hysterotomy was then closed. Results: The 3 patients recovered from surgery without inciden t. Early premature contractions subsided, and they were discharged by the 5th postoperative day. At between 33 and 36 weeks of gestation, ea ch infant was delivered via cesarean section. The observed neurologic deficits were within the range expected from the anatomic level of the defects. Two of the infants have not required ventriculoperitoneal sh unting. Conclusions: This limited series of patients suggests that mye lomeningocele can be repaired in utero with minimal morbidity to eithe r the mother or her fetus. A larger study will be needed to substantia te this low morbidity and to determine the extent of any neurologic be nefit of early surgery.