Open AccessPrenatal myelomeningocele repair: report of an inaugural case and considerations about the implementation of a new fetal neurosurgery program
Author(s) -
Carlos Eduardo Barros Jucá,
Francisco Herlânio Costa Carvalho,
Antônio Aldo Melo-Filho,
Fernanda Oliveira De Castro,
Denise Ellen Francelino Cordeiro,
Enzo Studart de Lucena Feitosa,
Renata Viana Brígido de Moura Jucá,
Francisco Edson de Lucena Feitosa
Publication year - 2022
Publication title -
archives of pediatric neurosurgery
Language(s) - English
Resource type - Journals
ISSN - 2675-3626
DOI - 10.46900/apn.v4i1(january-april).107
Subject(s) - spina bifida , fetal surgery , medicine , hydrocephalus , neurosurgery , pregnancy , neural tube defect , neural tube , surgery , spinal cord , fetus , in utero , embryo , psychiatry , biology , genetics , microbiology and biotechnology
Myelomeningocele (MMC) or open spina bifida is a neural tube defect which consists of a cleft in the vertebral column and a correspondent defect in the skin, causing the meninges and the spinal cord to be exposed. Despite some recommendations for nutrient supplementation during pregnancy, MMC remains very prevalent, especially in poor regions. MMC causes paralysis, urinary and gastrointestinal dysfunction, motor and neurological deficits, hydrocephalus and hindbrain herniation. Until 1997, the only way to repair this defect was performing surgery right after birth. In 2011, MOMS trial revealed a positive impact of prenatal surgery compared to postnatal. This paper reports the first case of one of the first myelomeningocele prenatal surgery programs in the North and Northeast regions of Brazil and discusses some issues about the implementation of new programs. The patient was a 34 years old woman in her second pregnancy, who was diagnosed at 22 weeks. She was submitted to an open fetal surgery applying MOMS protocol at 26 weeks of pregnancy and underwent cesarean at 36 weeks and five days of pregnancy. After two-years follow up, the baby girl did not need shunt for hydrocephalus, but has motor deficit in the lower limbs. Although fetal surgery is a high-tech procedure that demands a well-trained team, many families come from low-income regions. This way, the implementation of new services has an important social impact.