Fetal Surgery for Myelomeningocele

摘要

Myelomeningocele remains a major source of morbidity and mortality. Strides have been made in preventing these defects with folic acid supplementation, both for mothers with previously affected pregnancies, and for pregnancies in which there was no prior history of neural tube defects (NTD). Unfortunately, spina bifida still affects nearly 1 in 2,000 live births. It is estimated that 23(percent) of pregnancies in which the fetus is diagnosed with a NTD end in elective termination, but the remainder are ultimately delivered. Despite aggressive postnatal intervention, nearly 14(percent) of neo-nates with NTD do not survive past 5 years of age, with the mortality rising to 35(percent) among those with symptoms of brainstem dysfunction secondary to the Chiari II malformation. While 68(percent) of affected individuals have an IQ above 80, only half are able to live independently as adults. The cost of care exceeds Dollars 500 million per year (in 1992 dollars) in the United States alone.