Fetal Surgery for Myelomeningocele: Panacea or Peril?

Shinjiro Hirose  1 , Claudia Meuli-Simmen, Martin Meuli

Myelomeningocele affects thousands of children worldwide with devastating consequences. In an effort to improve neurologic outcome, fetal surgery has been performed for myelomeningocele for the past 5 years. Sensorimotor function is not appreciably improved, although there may be a reduction in hindbrain herniation and a decreased need for ventriculoperitoneal shunting. The long-term clinical consequences of these findings are not clear. What is clear, however, is that further study in the form of a prospective, randomized trial is mandatory.

Journal: World Journal of Surgery - published online: December 19, 2002

Date: 06/01/2003

1 The Fetal Treatment Center, Department of Surgery, Division of Pediatric Surgery, University of California, San Francisco, 513 Parnassus Avenue, Room HSW 1601, San Francisco, California 94143-0570, USA.

Hypoxia-regulated gene expression in fetal wound regeneration and adult wound repair

A Scheid1, R H Wenger1, H Christina1, I Camenisch1, A Ferenc1, U G Stauffer1, M Gassmann1, M Meuli1

Journal: PubMed

Date: 01/05/2002

1Department of Surgery, University Children's Hospital Zurich, Switzerland.

Prenatal diagnosis of a fetus with lumbar myelocystocele

N Kölble  1 , T A Huisman, T Stallmach, M Meuli, F Zen Ruffinen Imahorn, R Zimmermann

We present a case of a fetal lumbar myelocystocele, a rare congenital malformation, characterized by herniation of the central canal through a bony spina bifida. Routine ultrasound examination at 11 weeks' gestation by the primary obstetrician showed a suspicious cyst on the fetal back. Initially, the suspected diagnosis was a meningocele. After sonographic detection of newly developed fetal brain anomalies at 22 weeks' gestation the patient was referred to us. The enlarged cyst, which floated freely in the amniotic fluid, had a funnel-like appearance and was covered by a very thin layer of skin. With the help of ultrafast fetal magnetic resonance imaging the diagnosis of a fetal myelocystocele was made.

Journal: Ultrasound in Obstetrics & Gynecology (Volume 18, Issue 5, Pages 536-539)

Date: 01/11/2001

1 Unit of Perinatal Physiology, Department of Obstetrics, University Hospital, Zurich, Switzerland.

The Fetus with a Myelomeningocele (in: The Unborn Patient: The Art and Science of Fetal Therapy. 3rd ed. 2001, chapter 28:443-452. Authors: Michael R. Harrison, Mark I. Evans, N. Sc. Adzick. ISBN: 0-7216-8446-7)

Meuli M.

This popular reference returns in the 3rd Edition with an exciting new focus entirely committed to fetal therapy. Leading authorities from around the world provide comprehensive management strategies for several dozen diseases that can now be detected in utero. Each disease is covered in its own chapter providing all of the exciting new options in prenatal and postnatal treatment. Coverage includes updated information on pathophysiology and the technical aspects of treatment. This content also provides excellent teaching material for families considering or undergoing treatment.

Journal: Saunders: The Unborn Patient

Date: 01/01/2001

Assessment of sensory function in neonatal sheep with somatosensory evoked potentials: methodology and normative data

C D Yingling  1 , C Meuli-Simmen, M Meuli, G B Timmel, N S Adzick, M Harrison

Fetal sheep are increasingly used as animal models for fetal surgical interventions such as repair of myelomeningocele. Since behavioral observations cannot provide objective information about preservation of sensory function, we have developed a technique for reliably recording somatosensory evoked potentials in neonatal sheep. We determined anatomic criteria for placement of recording electrodes over the somatosensory cortex using external landmarks, and recorded normative data for both ulnar and posterior tibial nerve stimulation in a series of normal neonatal sheep. The methodology and normative data are presented in this report; a companion paper demonstrates the utilization of this technique in a variety of experimental fetal interventions.

Journal: Pediatric Surgery International 15, 530-534 (1999)

Date: 01/11/1999

1 Department of Neurological Surgery, University of California, San Francisco, USA.