物理医学与康复国际期刊
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Comparison between Intrauterine and Postnatal Myelomeningocele Repair Surgery: A Retrospective Longitudinal Study in Brazil

Anny Michelly Paquier Binha*, Leticia Miti Kuwae, Irina Hissami Yamamoto de Barros

Introduction: Myelomeningocele is one of the most common types of closed neural tube defect. Repair of this malformation should be conducted as early as possible to avoid contamination with the external environment. In 2011, an American randomized clinical trial was carried out showing there are neurological benefits in performing intrauterine surgery compared to postnatal surgery, with fewer cases of cerebrospinal fluid shunt and hindbrain herniation. In Brazil, this technique is not yet widespread and many services perform repair after birth.

Objective: To describe the epidemiological profile of individuals with myelomeningocele seen in an initial consultation, in a rehabilitation network in Brazil, between 2021 and 2023, with an emphasis on reducing cerebral herniation and fewer cases of hydrocephalus with ventriculoperitoneal shunt.

Method: This is a retrospective longitudinal study of individuals with neural tube closure defects seen in an initial consultation, based on electronic medical records at the Associação de Assistência à Criança Deficiente (AACD), between January 2021 and May 2023.

Results: A total of 262 patients diagnosed with spina bifida were evaluated, 237 patients with myelomeningocele. Of these, 59 (24.89%) were submitted to intrauterine repair, and 178 (75.11%) to postnatal repair. Hydrocephalus was more frequently observed in patients undergoing postpartum correction (92.3%) than intrauterine repair (78.2%) (p=0.004). In addition, ventriculoperitoneal shunt implantation was more frequent in patients undergoing postpartum repair (86.2%) than intrauterine procedure (13.8%) (p<0.001). It was not possible to identify a statistical difference as to hindbrain herniation, since only 14.3% of patients had the condition investigated. However, prematurity was more frequent in patients submitted to intrauterine repair (79.6%), whereas 66.3% of patients undergoing postnatal repair were not premature (p<0.001).

Conclusion: Patients undergoing intrauterine myelomeningocele repair had better neurological outcomes than those submitted to postnatal surgery, even with a higher frequency of prematurity.