Myelomeningocele
Everything in the library about myelomeningocele — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Surgical Management
2 items
Fetoscopic Repair of Myelomeningocele (MMC)
Listen →
Continuing our series on Fetal Surgery, today's episode reviews the basics of fetoscopic repair of myelomeningocele with Dr. Foong-Yen Lim, M.D. Host: Rod Gerardo
podcast5:52 · Aug 2021
Myelomeningoceles (open spina bifida) -Fetoscopic Intrauterine Myelomeningocele Closure
Watch →
In this educational video from Lurie Children’s Hospital, Dr. Robin Bowman walks us through a fetoscopic intrauterine myelomeningocele (MMC) closure, a cutting-edge surgical intervention for open neural tube defects diagnosed in utero.Key H
video3:41 · Dec 2025
Evidence & Research
3 items
Fetal Surgical Intervention for Myelomeningocele: Fetal Surgery 2012
Watch →
Dr. Adzick is the surgeon-in-chief and director of the Center for Fetal Diagnosis and Treatment at The Children’s Hospital of Philadelphia (CHOP). He gives his presentation on myelomeningocele (MMC), the most severe form of spin bifida. Top
video165:47 · Jan 2019
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
Listen →
We're back with the January issue of JPS article highlights. This time we're talking to editor Dr. Cassandra Kelleher and authors Drs. Gail Besner, Shahrazad Joharifard and Sarah Stokes with Dr. Todd Ponsky. Hosts: Ellen Encisco, Em Tombash
podcast13:09 · Feb 2022
Journal of Pediatric Surgery Article Highlights: April 2022
Listen →
We're back with the April issue of JPS article highlights. This time we're talking to Dr. Paul Tam and authors Dr. Natalie Lopyan and Dr. Christina Theodorou. Hosts: Em Tombash, Rod Gerardo, Brittany Levy Lopyan NM, Perrone EE, Gadepalli SK
podcast8:38 · Jul 2022
Case-Based Learning
1 item
Colorectal Quiz Episode 15: Bowel Management in Spinal Patients - Need for a UrologistPart 1
Listen →
Bowel management can be difficult on its own but for patients with spinal disorders, it can be exponentially more complex. Today, Dr. Levitt and Dr. Frischer discuss bowel management for this subset of patients and they brought some friends
podcast17:26 · Jun 2021
Summaries and takeaways+ Show
The doctors in this collection+ Show
All expert statements+ Show
Every expert statement below comes from the recorded discussions, with its speaker and moment.
Myelomeningoceles (open spina bifida) -Fetoscopic Intrauterine Myelomeningocele Closure
Myelomeningocele is a neural tube defect where the spinal cord does not close and is exposed on surface through an opening in the spine
clinical0:20 ↗
Myelomeningocele usually occurs in the low back region
clinical0:31 ↗
The incidence of neural tube defects is around 0.2 per 1000 live births in the United States
epidemiological0:33 ↗
When diagnosed prenatally, myelomeningoceles can be repaired during the fetal stage of life while in utero
clinical0:39 ↗
The pregnant patient is placed under general anesthesia and the uterus is approached by a midline laparotomy
clinical0:47 ↗
An ultrasound is used to map the location of the placenta and major vessels on the uterine surface
clinical0:55 ↗
Four full thickness sutures are placed through the uterine wall to delineate a 1 centimeter square area through which a 10 French trochar is inserted using Seldinger technique
clinical1:00 ↗
After removing a portion of the amniotic fluid, the uterus is insufflated with warm, humidified carbon dioxide
clinical1:14 ↗
Two subsequent trocars are placed under endoscopic visualization
clinical1:22 ↗
Prior to surgical intervention, the fetus is administered a sedative cocktail of rocuronium, fentanyl, and atropine
clinical1:26 ↗
Dissection of the myelomeningocele begins lateral to the exposed spinal cord, detaching it from the arachnoid and skin
clinical1:32 ↗
The spinal cord is circumferentially released, taking care not to injure the ascending spinal cord, lateral dorsal roots, or segmental vasculature
clinical1:41 ↗
Tenotomy scissors and right-angled hook electrocautery are used to sharply dissect through the tissue to completely free the placode
clinical1:51 ↗
The neural placode is reconstructed with interrupted 6-0 sutures after it is completely untethered from the skin
clinical1:59 ↗
The dura attaches laterally and ventrally to the open skin edge at the junctional zone
clinical2:06 ↗
Lateral fascia and muscle may be freed to allow medialization and primary closure of the dura under less tension
clinical2:16 ↗
A running, non-absorbable 6-0 suture is utilized to re-approximate the dura, which will persist long term and act as a useful guide if subsequent untethering is required
clinical2:24 ↗
Skin closure should be performed in the mid-sagittal plane when possible
clinical2:37 ↗
Skin mobilization may require including the subcutaneous fat layer, as the skin's vascular supply comes through this layer
clinical2:43 ↗
Blunt dissection in the plane between the muscle and subcutaneous fat is the best method to preserve the blood supply
clinical2:49 ↗
In some cases, the size of the skin defect may prevent primary skin closure
clinical2:55 ↗
A synthetic skin graft may be utilized and sutured to the edges of the healthy skin when primary closure is not possible
clinical3:00 ↗
The synthetic skin graft will promote eventual epithelialization of the open defect
clinical3:07 ↗
After completing the fetal back closure, the amniotic fluid is replaced in the uterus with warmed, lactated Ringer solution
clinical3:12 ↗
The ports are removed and the insertion sites are closed, the uterus is returned to the abdominal cavity and the abdominal incision is closed in the standard fashion
clinical3:19 ↗
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
Historically, surgeons have been incentivized based on work RVUs, which is important for clinical productivity but does not take advantage of other strengths surgeons have.
opinionGail Besner1:41 ↗
The concept of academic RVUs was first described approximately 12-13 years ago but did not include how to incentivize people for academic work.
clinicalGail Besner2:55 ↗
Nationwide Children's Hospital implemented a point-based academic RVU system where people accumulate points based on number of publications, presentations, and other academic pursuits.
clinicalGail Besner3:07 ↗
The Nationwide system kept work RVUs as part of the incentivization plan along with other goals that must be achievable.
clinicalGail Besner3:27 ↗
After implementing the academic RVU system, Nationwide had an increase in presentations, peer-reviewed publications, and external federal research funding.
host_summary3:44 ↗
What's new+ Show