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This Week in JAMA
November 17, 1999

This Week in JAMA

JAMA. 1999;282(19):1795. doi:10.1001/jama.282.19.1795

Edited by David H. Mark, MD, MPH, and Richard M. Glass, MD

Neurologic damage associated with myelomeningocele may occur in part because of exposure of neural tissue to the intrauterine environment, and alteration of cerebrospinal fluid circulation by drainage through the open defect may lead to hindbrain herniation and hydrocephalus. Bruner and colleagues reportArticle that the incidence of both hydrocephalus requiring ventriculoperitoneal shunt placement and hindbrain herniation was significantly reduced among 29 patients with fetal myelomeningocele surgically repaired between 24 and 30 weeks' gestation compared with 23 matched control patients, but the rate of preterm birth increased. In a case series of 10 patients with fetal myelomeningocele, Sutton and colleagues foundArticle that hindbrain herniation assessed by serial magnetic resonance imaging improved within 3 weeks of myelomeningocele closure performed at 22 to 25 weeks' gestation in 9 surviving newborns. In an editorialArticle, Simpson comments that fetal surgery for myelomeningocele is still an experimental procedure until associated obstetric complications are reduced and data about long-term functional outcomes become available.