Navegando por Palavras-chave "myelomeningocele"
Agora exibindo 1 - 8 de 8
Resultados por página
Opções de Ordenação
- ItemSomente MetadadadosAssessment of neurosurgical outcome in children prenatally diagnosed with myelomeningocele and development of a protocol for fetal surgery to prevent hydrocephalus(Springer, 2007-04-01) Zambelli, Helder; Carelli, Edmur; Honorato, Donizeti; Marba, Sergio; Coelho, Giselle; Carnevalle, Aline; Iscaife, Alexandre; Silva, Elton da; Barini, Ricardo; Sbragia, Lourenco; Universidade Estadual de Campinas (UNICAMP); Universidade Federal de São Paulo (UNIFESP)Prenatal diagnosis of myelomeningocele (MMC) has permitted a better planning for optimum management of the disease. More recently, it has allowed for a possible intrauterine repair of the spinal defect.To describe neurosurgical outcome in children with myelomeningocele and follow-up at a referral center in Fetal Medicine. Patients were characterized for the development of a protocol suitable for fetal surgery, and fetuses who were possible candidates for intrauterine surgery were identified.A retrospective descriptive analysis was performed of 98 cases of fetal myelomeningocele, seen at CAISM-UNICAMP, from January 1994 to December 2002, identifying cases with a possible indication for fetal surgery.Mean gestational age at diagnosis was 29 weeks (17-39); level of lesion was above the sacral region in 92.84%; association with hydrocephalus occurred in 78.57%. During clinical course, 82.5% of patients had neurogenic bladder and 60% had neural and mental deficits. Potential intrauterine repair rate was 11.57%, using criteria from the protocol developed in our service.Myelomeningocele is associated with severe and frequent sequelae. in virtually 12% of our cases, fetal surgery could have been offered as a therapeutic option.
- ItemSomente MetadadadosCystic spinal dysraphism of the cervical and upper thoracic region(Springer, 2006-03-01) Salomao, J. F.; Cavalheiro, S.; Matushita, H.; Leibinger, R. D.; Bellas, A. R.; Vanazzi, E.; Souza, LAM de; Nardi, A. G.; Oswaldo Cruz Fdn; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); CT Scan Ctr DiagnostBackground: Cystic dysraphic lesions of the cervical and upper thoracic region are rare and only a few series have been published about the topic. These malformations can be divided into categories that include both myelocystoceles and the so-called cervical meningoceles or myelomeningoceles. Methods: A retrospective study of 18 patients was conducted. Results: in 17 patients a squamous or a cicatricial epithelium of variable thickness covered the dome of the lesions, while the base was covered with full-thickness skin. in one case the skin was entirely normal. Four patients displayed associated CNS malformations and three more had systemic congenital anomalies. All patients underwent surgical exploration and the length of time between birth and surgery ranged from 6 h to 9 months. the most frequent surgical finding, seen in 14 patients, was a stalk connecting the dorsal surface of the spinal cord to the cyst. in three patients the findings were consistent with myelocystocele. Only in one case was a true meningocele found. Hydrocephalus and Chiari II malformation were not as consistently associated as in myelomeningoceles. Neurological signs and symptoms were not so marked as in myelomeningoceles and were found in the follow-up of four patients. in two of them there was a non-progressive deficit, probably expressing an imperceptible involvement of the nervous system in the first year of life. the histopathological findings were of three types: neuroglial stalks, fibrovascular stalks and myelocystoceles. Conclusions: Cystic dysraphisms of the cervical and upper thoracic region differ clinically and structurally from meningomyelocele and have a more favorable outcome. We believe that these malformations have not been properly labeled and propose a classification based on the structures found inside the cyst.
- ItemSomente MetadadadosEndoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial(Mosby-Elsevier, 2016) Pedreira, Denise A. L.; Zanon, Nelci [UNIFESP]; Nishikuni, Koshiro; Moreira de Sa, Renato A.; Acacio, Gregerio L.; Chmait, Ramen H.; Kontopoulos, Eftichia V.; Quintero, Ruben A.BACKGROUND: A recent randomized clinical trial named Management of Myelomeningocele Study (MOMS trial) showed that prenatal correction of open spina bifida (OSB) via open fetal surgery was associated with improved infant neurological outcomes relative to postnatal repair, but at the expense of increased maternal morbidity. OBJECTIVE: We sought to report the final results of our phase I trial (Cirurgia Endoscopica para Correcao Antenatalda Meningomielocele [CECAM]) on the feasibility, safety, potential benefits, and side effects of the fetoscopic treatment of OSB using our unique surgical technique. STUDY DESIGN: Ten consecutive pregnancies with lumbosacral OSB were enrolled in the study. Surgeries were performed percutaneously under general anesthesia with 3 ports and partial carbon dioxide insufflation. After appropriate surgical positioning of the fetus, the neuro-placode was released with scissors and the skin was undermined to place a biocellulose patch over the lesion. The skin was closed over the patch using a single running stitch. Preoperative, postoperative, and postnatal magnetic resonance imaging were performed to assess hindbrain herniation. Neurodevelopmental evaluation was performed before discharge and at 3, 6, and 12 months. All cases were delivered by cesarean delivery, at which time the uterus was assessed for evidence of thinning or dehiscence. RESULTS: The median gestational age at the time of surgery was 27 weeks (range 25-28 weeks). Endoscopic repair was completed in 8 of 10 fetuses. Two cases were unsuccessful due to loss of uterine access. The mean gestational age at birth was 32.4 weeks with a mean latency of 5.6 weeks between surgery and delivery (range 2-8 weeks). There was 1 fetal and 1 neonatal demise, and 1 unsuccessful case underwent postnatal repair. Of the 7 infants available for analysis, complete reversal of hindbrain herniation occurred in 6 of 7 babies. Three babies required ventriculoperitoneal shunting or third ventriculostomy. Functional motor level was the same or better than the anatomical level in 6 of 7 cases. There was no significant maternal morbidity and no evidence of myometrial thinning or dehiscence. However, surgeries were complicated by premature rupture of membrane and prematurity. CONCLUSION: Our study suggests that the antenatal treatment of OSB using a fetoscopic approach and our unique surgical technique can result in a watertight seal, reversal of the hindbrain herniation, and better than expected motor function. Our technique differs substantially from the classic repair of OSB used in prior open fetal surgery and fetoscopic studies, in which the dura mater is dissected and the defect is closed in multiple layers. Instead, we use a biocellulose patch placed over the lesion and simple closure of the skin. As such, our technique is an alternative to the current paradigms in the antenatal treatment of OSB. Our clinical outcomes are in line with the results of our extensive prior animal work. Maternal benefits of our approach and technique include minimal morbidity and no myometrial legacy. Current limitations of the approach include potential loss of access, premature rupture of membranes, and attendant prematurity. Phase II trials are needed to prevent these complications and to further assess the risks and benefits of our distinct surgical approach and technique.
- ItemSomente MetadadadosFetoscopic single-layer repair of open spina bifida using a cellulose patch: preliminary clinical experience(Informa Healthcare, 2014-11-01) Pedreira, Denise A. L.; Zanon, Nelci [UNIFESP]; Sa, Renato A. M. de; Acacio, Gregorio L.; Ogeda, Edilson; Belem, Teresa M. L. O. U.; Chmait, Ramen H.; Kontopoulos, Eftichia; Quintero, Ruben A.; Universidade de São Paulo (USP); Samaritano Hosp; Universidade Federal de São Paulo (UNIFESP); Universidade Federal Fluminense (UFF); Univ Taubate; Univ So Calif; Jackson Mem HospObjective: To report our preliminary clinical experience in the antenatal correction of open spina bifida (OSB) using a fetoscopic approach and a simplified closure technique.Methods: Four fetuses with lumbar-sacral defects were operated in utero from 25 to 27 weeks. Surgeries were performed percutaneously under general anesthesia using three trocars and partial carbon dioxide insufflation. After dissection of the neural placode, the surrounding skin was closed over a cellulose patch using a single continuous stitch.Results: Surgical closure was successful in three of the four cases. All successful cases showed improvement of the hindbrain herniation and no neonatal neurosurgical repair was required in two cases. Delivery occurred between 31 and 33 weeks, and no fetal or neonatal deaths occurred. Ventriculoperitoneal shunting was not needed in two out of the 3 successful cases.Conclusions: Our preliminary experience suggests that definitive fetoscopic repair of OSB is feasible using our innovative surgical technique. A phase I trial for the fetoscopic correction of OSB with this technique is currently being conducted.
- ItemSomente MetadadadosGait analysis in low lumbar myelomeningocele patients with unilateral hip dislocation or subluxation(Lippincott Williams & Wilkins, 2003-05-01) Gabrieli, APT; Vankoski, S. J.; Dias, L. S.; Milani, C.; Lourenco, A.; Laredo, T.; Novak, R.; Northwestern Univ; Universidade Federal de São Paulo (UNIFESP)The surgical indications for the treatment of unilateral hip dislocations or subluxations in patients with low lumbar myelomeningocele remain highly debatable. This study examines the influence of unilateral hip dislocation or subluxation on the gait of these patients using three-dimensional gait analysis. Twenty patients with a diagnosis of low lumbar myelomeningocele underwent three-dimensional gait analysis. All patients were community ambulators with solid ankle-foot orthoses and crutches who presented with unilateral hip dislocation or subluxation and no scoliosis. the patients were divided in two groups. Group 1 comprised 10 patients who demonstrated either no evidence of hip flexion or adduction contractures or symmetric hip contractures. Group 2 comprised 10 patients with unilateral hip flexion and/or adduction contractures. Pelvic and hip kinematics were assessed to determine the symmetry of motion between the involved and the noninvolved side during walking. Seven patients from group 1 walked with a symmetric gait pattern; only two patients from group 2 walked with a symmetric pattern. Gait symmetry corresponded to the absence of hip contractures or bilateral symmetrical hip contractures and had no relation to the presence of hip dislocation. the authors concluded that reduction of the hip is unnecessary.
- ItemAcesso aberto (Open Access)Histological evidence of reparative activity in chorioamniotic membrane following open fetal surgery for myelomeningocele(Spandidos Publ Ltd, 2017) Carvalho, Natalia S. [UNIFESP]; Moron, Antonio F. [UNIFESP]; Menon, Ramkumar; Cavalheiro, Sergio [UNIFESP]; Barbosa, Mauricio M. [UNIFESP]; Milani, Herbene J. [UNIFESP]; Ishigai, Marcia M. [UNIFESP]An increased understanding of the reparative process in fetal membrane following surgical techniques may be helpful to decrease the risks to mother and fetus and avoid adverse pregnancy outcomes. The present study discusses histological evaluation of the fetal membrane following open fetal surgery. Chorioamniotic membranes (n=10) were obtained following birth from pregnancies that underwent open fetal surgery for myelomeningocele. The collagen distribution was quantified using picrosirius-polarization method comparing the suture site with non-suture site. The differences between the collagen fiber percentages at the two sites was evaluated by the paired t-test with P<0.05. The mean gestational age of fetal surgery was 26.09 +/- 0.3 and 33.81 +/- 0.82 weeks at birth. The picrosirius red sign was more intense at the suture site, primarily associated with collagen type 1. Collagen observed in the surgical area was significantly increased (13.22 +/- 2.84%) compared with the non-surgical area (6.16 +/- 1.09%
- ItemAcesso aberto (Open Access)Improvement of motor function and decreased need for postnatal shunting in children who had undergone intrauterine myelomeningocele repair(Academia Brasileira de Neurologia - ABNEURO, 2013-09-01) Faria, Tereza Cristina Carbonari de; Cavalheiro, Sergio [UNIFESP]; Hisaba, Wagner Jou [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Torloni, Maria Regina [UNIFESP]; Oliveira, Ana Lucia Batista de; Borges, Carolina Peixoto; Universidade Federal de São Paulo (UNIFESP); Hospital Israelita Albert EinsteinObjective To compare neuromotor development between patients who did and those who did not undergo intrauterine myelomeningocele repair. Methods Children with myelomeningocele aged between 3.5 and 6 years who did undergo intrauterine repair (Group A, n=6) or not (Group B; n=7) were assessed for neuromotor development at both anatomical and functional levels, need for orthoses, and cognitive function. Results Intrauterine myelomeningocele repair significantly improved motor function. The functional level was higher than the anatomical level by 2 or more spinal segments in all children in Group A and 2 children in Group B, with a significant statistical difference between groups (p<0.05). Five children in Group A and one in Group B were community ambulators. Conclusion Despite the small sample, it was observed that an improvement of motor function and decreased need for postnatal shunting in the 6 children who had undergone intrauterine myelomeningocele repair.
- ItemSomente MetadadadosUpper and lower urinary tract evaluation of 104 patients with myelomeningocele without adequate urological management(Springer, 2006-06-01) Bruschini, H.; Almeida, F. G.; Srougi, M.; Universidade Federal de São Paulo (UNIFESP)To evaluate the upper and lower urinary tract and revise the urodynamic parameters on myelomeningocele patients without adequate urological management. 104 myelomeningocele patients without previous adequate urological management were assessed by clinical, urodynamic and imaging evaluation. the urodynamic.data were correlated with the status of the upper urinary tract (UUT). Thirty patients presented with vesico-ureteral reflux. Six patients presented signs of UUT damage without reflux. the cystometry showed detrusor overactivity (DO), poor compliance, increased bladder capacity and normal cystometry in 48, 49, 2 and 1% of the patients, respectively.Detrusor leak point pressure (DLPP) over 40 cm H2O was associated with UUT damage. Patients with decrease on functional bladder capacity (FBC) <= 33% had more renal scars than their counterparts (P = 0.01). Overall, urological untreated myelomeningocele patients have 26% of kidney damage. DLPP >= 40cmH(2)O and decrease in FBC <= 33% are associated with greater UUT damage. DO and poor compliance are predominant and pose similar risk of UUT damage.