Surgical Management of Myelomeningocele

¹Department of Neurosurgery, University of Florida, Gainesville, FL, USA

²Department of Neuroscience, University of Johns Hopkins, Baltimore, MD, USA

³University of Florida, College of Medicine, Gainesville, FL, USA

⁴University of Nevada, Reno School of Medicine, Reno, NV, USA

*Corresponding Author: Dr. Brandon Lucke-Wold, Lillian S. Wells Department of Neurosurgery, University of Florida College of Medicine, 1505 SW Archer Road, Gainesville, FL 32608, USA; Tel: (352) 273-6990 Email: [email protected]

Received Date: March 27, 2023

Publication Date: May 15, 2023

Citation: Hosseini-Siyanaki MR, et al. (2023). Surgical Management of Myelomeningocele. Neonatal. 4(1):8.

Copyright: Hosseini-Siyanaki MR, et al. © (2023). 

ABSTRACT

Myelomeningocele (MMC) is one of the most common abnormalities of the central nervous system that causes significant neurological impairment. Traditionally, treatment consisted of postnatal closure with the management of the complications, such as ventricular shunting. MMC is a plausible candidate for in-utero surgery because of the mechanism of neurologic damage that begins with abnormal neurulation and continues throughout gestation. Researchers discussed the benefits of in-utero closure prior to the publication of the prospective randomized multicenter Management of Myelomeningocele Study (MOMS trial). Compared to postnatal repair with maternal complications and prematurity as trade-offs, prenatal repair reduced shunting, reversed hindbrain herniation, and improved neurological function. This article discusses the diagnosis, evaluation, long-term follow-up, surgical options, and innovative treatment for fetal myelomeningocele.

Keyword: Myelomeningoceles; Hydrocephalus; Fetal surgery; Management of Myelomeningocele Study; Postnatal surgery; Prenatal surgery

Abbreviations: Myelomeningoceles (MMCs); Neural tube defects (NTDs); Maternal serum alpha-fetoprotein (MSAFP); Cerebrospinal fluid (CSF); Magnetic resonance imaging (MRI); The Management of Myelomeningocele Study (MOMS); Ventriculoperitoneal (VP); endoscopic third ventriculostomy (ETV); Chiari II malformation (C2M); Premature rupture of membranes (PROM); Tethered spinal cord (TSC); Platelet-rich plasma (PRP); Placental mesenchymal stem cells (PMSCs); Platelet-derived growth factor (PDGF); Vascular endothelial growth factor (VEGF); Epidermal growth factor (EGF); Platelet-derived factor 4 (PF-4); Insulin-like growth factor (IGF-1); Transforming growth factor-beta (TGF-b)