Article

Myelomeningocele (MMC), one of the most common congenital malformations, can
result in severe lifelong disabilities, including paraplegia, hydrocephalus,
Chiari II malformation, bowel and bladder dysfunction, skeletal deformations, and
neurocognitive impairment. Experimental studies provide compelling evidence that
the neurological deficits associated with MMC are not simply caused by incomplete
neurulation but rather by the prolonged exposure of the vulnerable neural
elements to the intrauterine environment. MMC is the first non-lethal anomaly
considered for fetal surgical intervention, necessitating a careful analysis of
risks and benefits. Retrospective and prospective randomized studies suggest that
fetal surgery of MMC before 26 weeks of gestation may preserve neuromotor
function, reverse hindbrain herniation, and reduce the need for
ventriculoperitoneal shunting. However, these studies also demonstrate that fetal
surgery is associated with significant maternal and fetal risks. Consequently,
additional research is necessary to further elucidate the pathophysiology of MMC,
to define the ideal timing and technique of fetal closure, and to evaluate the
long-term implications of prenatal intervention.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2011 Mac Keith
Press.

Langue : ANGLAIS