Spina Bifida
Everything in the library about spina bifida — 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
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Fetoscopic Repair of Myelomeningocele (MMC)
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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
Evidence & Research
1 item
Fetal Surgical Intervention for Myelomeningocele: Fetal Surgery 2012
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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
Case-Based Learning
2 items
Colorectal Quiz Episode 15: Bowel Management in Spinal Patients - Need for a UrologistPart 1
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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
Colorectal Quiz Episode 16: Bowel Management in Spinal Patients - Need for a Urologist Part 2
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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
podcast14:18 · Jul 2021
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Fetal Surgical Intervention for Myelomeningocele: Fetal Surgery 2012
Spina bifida affects approximately 1500 babies born per year in the US, about 30 per week or 5-6 per day.
epidemiologicalScott Adzik82:06 ↗
With standard postnatal care, approximately 14% of MMC patients die by age 5, mostly due to symptomatic brain stem compression from hindbrain herniation.
clinicalScott Adzik83:20 ↗
About 85% of MMC patients require ventricular shunts with standard postnatal care, with approximately half developing shunt complications within one year.
clinicalScott Adzik83:33 ↗
The two-hit hypothesis for MMC proposes that secondary damage occurs in utero from amniotic fluid, meconium, or hydrodynamic forces after the initial failure of neurulation.
clinicalScott Adzik83:41 ↗
In fetal sheep models, mid-gestational spinal cord exposure leads to progressive neurologic injury that mimics human MMC, with paralysis and loss of sensation below the lesion level.
clinicalScott Adzik86:09 ↗
In utero coverage of experimentally created MMC in fetal sheep rescues neurologic function at birth, with lambs able to stand, walk, and maintain continence.
host_summaryScott Adzik86:43 ↗
Hindbrain herniation reverses after prenatal MMC repair because closing the defect prevents CSF leak, reestablishing the pressure column in the spinal canal.
clinicalScott Adzik90:15 ↗
In CHOP's pre-MOMS experience with 50 fetal MMC repairs, the shunt rate by one year was 40%, compared to 85% with postnatal repair.
clinicalScott Adzik93:10 ↗
Two-thirds of prenatally repaired MMC patients showed motor function two or more levels better than the anatomic lesion level.
clinicalScott Adzik93:41 ↗
The MOMS trial was stopped early on December 7, 2010 by the Data Safety Monitoring Board due to demonstrated efficacy of prenatal surgery.
clinicalScott Adzik102:18 ↗
In the MOMS trial, shunts were placed in 40% of the prenatal surgery group compared to 82% of the postnatal surgery group.
clinicalScott Adzik102:55 ↗
At 30 months, 42% of babies in the prenatal surgery group could walk independently versus only 21% in the postnatal surgery group.
clinicalScott Adzik103:31 ↗
Mean gestational age at delivery was 34 weeks in the prenatal surgery group versus 37 weeks in the postnatal group, with 13% of prenatal cases delivered before 30 weeks.
clinicalScott Adzik104:57 ↗
At the time of delivery in the MOMS trial, the hysterotomy site was intact in about two-thirds of cases, very thin in one-quarter, with dehiscence in 9% and complete dehiscence in one case.
clinicalScott Adzik104:32 ↗
Since the end of the MOMS trial, CHOP has had 359 referrals, with 202 evaluated on-site, but only 60 (30%) underwent fetal surgery.
clinicalScott Adzik107:57 ↗
Fetal MRI is mandatory for preoperative evaluation because ultrasound alone can incorrectly identify hindbrain herniation; in 9 cases with absent hindbrain herniation on MRI, ultrasound showed positive or equivocal findings.
clinicalScott Adzik109:07 ↗
Fetoscopic MMC repair using 3 or more ports leads to membrane fixation and tearing with uterine growth, resulting in premature birth 3-6 weeks after surgery and delivery before 30 weeks as a rule.
clinicalScott Adzik109:47 ↗
Compared to open fetal MMC repair, fetoscopic repair has higher rates of fetal death, premature rupture of membranes, chorioamnionitis, oligohydramnios, premature delivery, and persistent hindbrain herniation.
clinicalScott Adzik110:06 ↗
There have been three maternal deaths associated with open fetal surgery for MMC in South America (one in Colombia, two in Argentina).
host_summaryTodd Ponsky132:16 ↗
In the US experience with open fetal surgery for MMC, there have been no maternal deaths and no serious maternal complications in recent years.
clinicalTodd Ponsky133:43 ↗
Longer operating room times and postoperative oligohydramnios correlate with increased risk for preterm birth in fetal MMC repair.
clinicalScott Adzik106:17 ↗
A Washington University financial model using MOMS trial data showed that over $3 million would be saved for 100 babies treated prenatally versus postnatally.
host_summaryScott Adzik107:07 ↗
In Europe, approximately one-third of mothers decline open fetal MMC surgery because it is an open procedure.
epidemiologicalTodd Ponsky146:39 ↗
For proper neurosurgical repair of cystic MMC, it is essential to remove the cyst and excise tissues that don't belong, not simply cover the lesion—a step that may be missing in some fetoscopic approaches.
clinicalTodd Ponsky147:34 ↗
In the MOMS trial, 51% of prenatally repaired children met shunt criteria, but only 31 actually received shunts (approximately 65% of those meeting criteria), compared to 66 of 74 (89%) in the postnatal group.
clinicalTodd Ponsky150:23 ↗
The discrepancy between meeting shunt criteria and receiving shunts occurred because an independent neurosurgical review committee determined criteria, but individual neurosurgeons made placement decisions, and most discrepancies involved criterion 3 (head size/ventricle changes) without accompanying symptoms.
host_summaryScott Adzik154:14 ↗
Using revised shunt criteria based on modified criterion 3, there is a close match between shunt criteria and actual shunt placement in both prenatal (46%) and postnatal (86%) groups.
host_summaryScott Adzik156:43 ↗
Colorectal Quiz Episode 15: Bowel Management in Spinal Patients - Need for a UrologistPart 1
About 5% of colorectal work is surgical and the rest is bowel management.
host_summaryRebecca Rentia1:48 ↗
MiraLax softens stool but does not provide a 'push' to expel it, which can leave the colon full of soft stool.
clinicalChristine Warner6:16 ↗
Senna and bisacodyl are the two medications that provide a 'kick' or push for stool expulsion; everything else is a stool softener.
clinicalMarc Levitt6:59 ↗
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