Fetal Surgical Intervention for Myelomeningocele: Fetal Surgery 2012
▶Ep 8 · 46:05
quoteNew procedures are developed in the centers where the people are, the people that is, who feel a personal motivation to develop them.↗
▶Ep 8 · 46:05
quoteNew procedures are developed in the centers where the people are, the people that is, who feel a personal motivation to develop them.↗
▶Ep 8 · 1:22:06
epidemiologicalSpina bifida affects approximately 1500 babies born per year in the US, about 30 per week or 5-6 per day.↗
▶Ep 8 · 1:22:06
epidemiologicalSpina bifida affects approximately 1500 babies born per year in the US, about 30 per week or 5-6 per day.↗
▶Ep 8 · 1:23:20
clinicalWith standard postnatal care, approximately 14% of MMC patients die by age 5, mostly due to symptomatic brain stem compression from hindbrain herniation.↗
▶Ep 8 · 1:23:20
clinicalWith standard postnatal care, approximately 14% of MMC patients die by age 5, mostly due to symptomatic brain stem compression from hindbrain herniation.↗
▶Ep 8 · 1:23:33
clinicalAbout 85% of MMC patients require ventricular shunts with standard postnatal care, with approximately half developing shunt complications within one year.↗
▶Ep 8 · 1:23:33
clinicalAbout 85% of MMC patients require ventricular shunts with standard postnatal care, with approximately half developing shunt complications within one year.↗
▶Ep 8 · 1:23:41
clinicalThe 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.↗
▶Ep 8 · 1:23:41
clinicalThe 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.↗
▶Ep 8 · 1:26:09
clinicalIn 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.↗
▶Ep 8 · 1:26:09
clinicalIn 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.↗
▶Ep 8 · 1:26:43
clinicalIn utero coverage of experimentally created MMC in fetal sheep rescues neurologic function at birth, with lambs able to stand, walk, and maintain continence.↗
▶Ep 8 · 1:26:43
host_summaryIn utero coverage of experimentally created MMC in fetal sheep rescues neurologic function at birth, with lambs able to stand, walk, and maintain continence.↗
▶Ep 8 · 1:30:15
clinicalHindbrain herniation reverses after prenatal MMC repair because closing the defect prevents CSF leak, reestablishing the pressure column in the spinal canal.↗
▶Ep 8 · 1:30:15
clinicalHindbrain herniation reverses after prenatal MMC repair because closing the defect prevents CSF leak, reestablishing the pressure column in the spinal canal.↗
▶Ep 8 · 1:33:10
clinicalIn CHOP's pre-MOMS experience with 50 fetal MMC repairs, the shunt rate by one year was 40%, compared to 85% with postnatal repair.↗
▶Ep 8 · 1:33:10
clinicalIn CHOP's pre-MOMS experience with 50 fetal MMC repairs, the shunt rate by one year was 40%, compared to 85% with postnatal repair.↗
▶Ep 8 · 1:33:41
clinicalTwo-thirds of prenatally repaired MMC patients showed motor function two or more levels better than the anatomic lesion level.↗
▶Ep 8 · 1:33:41
clinicalTwo-thirds of prenatally repaired MMC patients showed motor function two or more levels better than the anatomic lesion level.↗
▶Ep 8 · 1:42:18
clinicalThe MOMS trial was stopped early on December 7, 2010 by the Data Safety Monitoring Board due to demonstrated efficacy of prenatal surgery.↗
▶Ep 8 · 1:42:18
clinicalThe MOMS trial was stopped early on December 7, 2010 by the Data Safety Monitoring Board due to demonstrated efficacy of prenatal surgery.↗
▶Ep 8 · 1:42:55
clinicalIn the MOMS trial, shunts were placed in 40% of the prenatal surgery group compared to 82% of the postnatal surgery group.↗
▶Ep 8 · 1:42:55
clinicalIn the MOMS trial, shunts were placed in 40% of the prenatal surgery group compared to 82% of the postnatal surgery group.↗
▶Ep 8 · 1:43:31
clinicalAt 30 months, 42% of babies in the prenatal surgery group could walk independently versus only 21% in the postnatal surgery group.↗
▶Ep 8 · 1:43:31
clinicalAt 30 months, 42% of babies in the prenatal surgery group could walk independently versus only 21% in the postnatal surgery group.↗
▶Ep 8 · 1:44:32
clinicalAt 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.↗
▶Ep 8 · 1:44:32
clinicalAt 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.↗
▶Ep 8 · 1:44:57
clinicalMean 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.↗
▶Ep 8 · 1:44:57
clinicalMean 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.↗
▶Ep 8 · 1:45:42
quotePrenatal repair of myelomeningocele is not a cure.↗
▶Ep 8 · 1:45:42
quotePrenatal repair of myelomeningocele is not a cure.↗
▶Ep 8 · 1:46:17
clinicalLonger operating room times and postoperative oligohydramnios correlate with increased risk for preterm birth in fetal MMC repair.↗
▶Ep 8 · 1:46:17
clinicalLonger operating room times and postoperative oligohydramnios correlate with increased risk for preterm birth in fetal MMC repair.↗
▶Ep 8 · 1:47:07
epidemiologicalA Washington University financial model using MOMS trial data showed that over $3 million would be saved for 100 babies treated prenatally versus postnatally.↗
▶Ep 8 · 1:47:07
host_summaryA Washington University financial model using MOMS trial data showed that over $3 million would be saved for 100 babies treated prenatally versus postnatally.↗
▶Ep 8 · 1:47:57
clinicalSince the end of the MOMS trial, CHOP has had 359 referrals, with 202 evaluated on-site, but only 60 (30%) underwent fetal surgery.↗
▶Ep 8 · 1:47:57
clinicalSince the end of the MOMS trial, CHOP has had 359 referrals, with 202 evaluated on-site, but only 60 (30%) underwent fetal surgery.↗
▶Ep 8 · 1:49:07
clinicalFetal 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.↗
▶Ep 8 · 1:49:07
clinicalFetal 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.↗
▶Ep 8 · 1:49:47
clinicalFetoscopic 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.↗
▶Ep 8 · 1:49:47
clinicalFetoscopic 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.↗
▶Ep 8 · 1:50:06
clinicalCompared 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.↗
▶Ep 8 · 1:50:06
clinicalCompared 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.↗
▶Ep 8 · 2:34:14
host_summaryThe 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.↗
▶Ep 8 · 2:34:14
clinicalThe 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.↗
▶Ep 8 · 2:36:43
clinicalUsing 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.↗
▶Ep 8 · 2:36:43
host_summaryUsing 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.↗
Fetal Surgical Intervention for Myelomeningocele: Fetal Surgery 2012
▶Ep 1 · 46:05
quoteNew procedures are developed in the centers where the people are, the people that is, who feel a personal motivation to develop them.↗
▶Ep 1 · 1:22:06
epidemiologicalSpina bifida affects approximately 1500 babies born per year in the US, about 30 per week or 5-6 per day.↗
▶Ep 1 · 1:23:20
clinicalWith standard postnatal care, approximately 14% of MMC patients die by age 5, mostly due to symptomatic brain stem compression from hindbrain herniation.↗
▶Ep 1 · 1:23:33
clinicalAbout 85% of MMC patients require ventricular shunts with standard postnatal care, with approximately half developing shunt complications within one year.↗
▶Ep 1 · 1:23:41
clinicalThe 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.↗
▶Ep 1 · 1:26:09
clinicalIn 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.↗
▶Ep 1 · 1:26:43
clinicalIn utero coverage of experimentally created MMC in fetal sheep rescues neurologic function at birth, with lambs able to stand, walk, and maintain continence.↗
▶Ep 1 · 1:30:15
clinicalHindbrain herniation reverses after prenatal MMC repair because closing the defect prevents CSF leak, reestablishing the pressure column in the spinal canal.↗
▶Ep 1 · 1:33:10
clinicalIn CHOP's pre-MOMS experience with 50 fetal MMC repairs, the shunt rate by one year was 40%, compared to 85% with postnatal repair.↗
▶Ep 1 · 1:33:41
clinicalTwo-thirds of prenatally repaired MMC patients showed motor function two or more levels better than the anatomic lesion level.↗
▶Ep 1 · 1:42:18
clinicalThe MOMS trial was stopped early on December 7, 2010 by the Data Safety Monitoring Board due to demonstrated efficacy of prenatal surgery.↗
▶Ep 1 · 1:42:55
clinicalIn the MOMS trial, shunts were placed in 40% of the prenatal surgery group compared to 82% of the postnatal surgery group.↗
▶Ep 1 · 1:43:31
clinicalAt 30 months, 42% of babies in the prenatal surgery group could walk independently versus only 21% in the postnatal surgery group.↗
▶Ep 1 · 1:44:32
clinicalAt 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.↗
▶Ep 1 · 1:44:57
clinicalMean 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.↗
▶Ep 1 · 1:45:42
quotePrenatal repair of myelomeningocele is not a cure.↗
▶Ep 1 · 1:46:17
clinicalLonger operating room times and postoperative oligohydramnios correlate with increased risk for preterm birth in fetal MMC repair.↗
▶Ep 1 · 1:47:07
epidemiologicalA Washington University financial model using MOMS trial data showed that over $3 million would be saved for 100 babies treated prenatally versus postnatally.↗
▶Ep 1 · 1:47:57
clinicalSince the end of the MOMS trial, CHOP has had 359 referrals, with 202 evaluated on-site, but only 60 (30%) underwent fetal surgery.↗
▶Ep 1 · 1:49:07
clinicalFetal 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.↗
▶Ep 1 · 1:49:47
clinicalFetoscopic 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.↗
▶Ep 1 · 1:50:06
clinicalCompared 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.↗
▶Ep 1 · 2:34:14
clinicalThe 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.↗
▶Ep 1 · 2:36:43
clinicalUsing 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.↗
Fetal Surgical Intervention for Myelomeningocele: Fetal Surgery 2012
▶Ep 1 · 46:05
quoteNew procedures are developed in the centers where the people are, the people that is, who feel a personal motivation to develop them.↗
▶Ep 1 · 1:22:06
epidemiologicalSpina bifida affects approximately 1500 babies born per year in the US, about 30 per week or 5-6 per day.↗
▶Ep 1 · 1:23:20
clinicalWith standard postnatal care, approximately 14% of MMC patients die by age 5, mostly due to symptomatic brain stem compression from hindbrain herniation.↗
▶Ep 1 · 1:23:33
clinicalAbout 85% of MMC patients require ventricular shunts with standard postnatal care, with approximately half developing shunt complications within one year.↗
▶Ep 1 · 1:23:41
clinicalThe 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.↗
▶Ep 1 · 1:26:09
clinicalIn 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.↗
▶Ep 1 · 1:26:43
host_summaryIn utero coverage of experimentally created MMC in fetal sheep rescues neurologic function at birth, with lambs able to stand, walk, and maintain continence.↗
▶Ep 1 · 1:30:15
clinicalHindbrain herniation reverses after prenatal MMC repair because closing the defect prevents CSF leak, reestablishing the pressure column in the spinal canal.↗
▶Ep 1 · 1:33:10
clinicalIn CHOP's pre-MOMS experience with 50 fetal MMC repairs, the shunt rate by one year was 40%, compared to 85% with postnatal repair.↗
▶Ep 1 · 1:33:41
clinicalTwo-thirds of prenatally repaired MMC patients showed motor function two or more levels better than the anatomic lesion level.↗
▶Ep 1 · 1:42:18
clinicalThe MOMS trial was stopped early on December 7, 2010 by the Data Safety Monitoring Board due to demonstrated efficacy of prenatal surgery.↗
▶Ep 1 · 1:42:55
clinicalIn the MOMS trial, shunts were placed in 40% of the prenatal surgery group compared to 82% of the postnatal surgery group.↗
▶Ep 1 · 1:43:31
clinicalAt 30 months, 42% of babies in the prenatal surgery group could walk independently versus only 21% in the postnatal surgery group.↗
▶Ep 1 · 1:44:32
clinicalAt 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.↗
▶Ep 1 · 1:44:57
clinicalMean 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.↗
▶Ep 1 · 1:45:42
quotePrenatal repair of myelomeningocele is not a cure.↗
▶Ep 1 · 1:46:17
clinicalLonger operating room times and postoperative oligohydramnios correlate with increased risk for preterm birth in fetal MMC repair.↗
▶Ep 1 · 1:47:07
host_summaryA Washington University financial model using MOMS trial data showed that over $3 million would be saved for 100 babies treated prenatally versus postnatally.↗
▶Ep 1 · 1:47:57
clinicalSince the end of the MOMS trial, CHOP has had 359 referrals, with 202 evaluated on-site, but only 60 (30%) underwent fetal surgery.↗
▶Ep 1 · 1:49:07
clinicalFetal 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.↗
▶Ep 1 · 1:49:47
clinicalFetoscopic 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.↗
▶Ep 1 · 1:50:06
clinicalCompared 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.↗
▶Ep 1 · 2:34:14
host_summaryThe 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.↗
▶Ep 1 · 2:36:43
host_summaryUsing 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.↗