Good long-term outcomes for fetal myelomeningocele surgery

(HealthDay)—Fetal myelomeningocele (fMMC) surgery is associated with improved long-term functional outcomes, according to a study published in the February issue of the American Journal of Obstetrics & Gynecology.

Enrico Danzer, M.D., from the Children's Hospital of Philadelphia, and colleagues examined long-term neurological outcome, executive functioning (EF), and behavioral adaptive skills (BAS) after fMMC surgery. Parents of 42 of the 54 children who underwent fMMC surgery participated in structured questionnaires relating to neurofunctional outcome.

The researchers found that 79 percent of patients were community ambulators, 9 percent were household ambulators, and 14 percent were wheelchair dependent at a median follow-up of 10 years. Preschool ambulation predicted long-term ambulation (P < 0.01); persistent deterioration of ambulatory status was seen in association with the need for tethered cord surgery (P = 0.007). Twenty-six percent of children had normal bladder function. Most patients scored within the average range for the Behavioral Regulation Index, Metacognition Index, and Global Executive Composite indices of the Behavior Rating Inventory of Executive Function; however, compared with population norms, more children who had fMMC surgery had deficits in EF in all three indices. Normal early neurodevelopmental outcomes were able to predict normal EF and BAS (P < 0.01). Significant impairment of BAS was seen with the need for shunting (P = 0.02).

"The present study suggests that fMMC surgery improves long-term functional outcome," the authors write.

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