Myelomeningocele
Everything in the library about myelomeningocele — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Surgical Management
2 items
Fetoscopic Repair of Myelomeningocele (MMC)
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Continuing our series on Fetal Surgery, today's episode reviews the basics of fetoscopic repair of myelomeningocele with Dr. Foong-Yen Lim, M.D. Host: Rod Gerardo
podcast5:52 · Aug 2021
Myelomeningoceles (open spina bifida) -Fetoscopic Intrauterine Myelomeningocele Closure
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In this educational video from Lurie Children’s Hospital, Dr. Robin Bowman walks us through a fetoscopic intrauterine myelomeningocele (MMC) closure, a cutting-edge surgical intervention for open neural tube defects diagnosed in utero.Key H
video3:41 · Dec 2025
Evidence & Research
3 items
Fetal Surgical Intervention for Myelomeningocele: Fetal Surgery 2012
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Dr. Adzick is the surgeon-in-chief and director of the Center for Fetal Diagnosis and Treatment at The Children’s Hospital of Philadelphia (CHOP). He gives his presentation on myelomeningocele (MMC), the most severe form of spin bifida. Top
video165:47 · Jan 2019
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
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We're back with the January issue of JPS article highlights. This time we're talking to editor Dr. Cassandra Kelleher and authors Drs. Gail Besner, Shahrazad Joharifard and Sarah Stokes with Dr. Todd Ponsky. Hosts: Ellen Encisco, Em Tombash
podcast13:09 · Feb 2022
Journal of Pediatric Surgery Article Highlights: April 2022
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We're back with the April issue of JPS article highlights. This time we're talking to Dr. Paul Tam and authors Dr. Natalie Lopyan and Dr. Christina Theodorou. Hosts: Em Tombash, Rod Gerardo, Brittany Levy Lopyan NM, Perrone EE, Gadepalli SK
podcast8:38 · Jul 2022
Case-Based Learning
1 item
Colorectal Quiz Episode 15: Bowel Management in Spinal Patients - Need for a UrologistPart 1
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Bowel management can be difficult on its own but for patients with spinal disorders, it can be exponentially more complex. Today, Dr. Levitt and Dr. Frischer discuss bowel management for this subset of patients and they brought some friends
podcast17:26 · Jun 2021
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Journal of Pediatric Surgery Article Review: January 2022 APSA Issue
Historically, surgeons have been incentivized based on work RVUs, which is important for clinical productivity but does not take advantage of other strengths surgeons have.
opinionGail Besner1:41 ↗
The concept of academic RVUs was first described approximately 12-13 years ago but did not include how to incentivize people for academic work.
clinicalGail Besner2:55 ↗
Nationwide Children's Hospital implemented a point-based academic RVU system where people accumulate points based on number of publications, presentations, and other academic pursuits.
clinicalGail Besner3:07 ↗
The Nationwide system kept work RVUs as part of the incentivization plan along with other goals that must be achievable.
clinicalGail Besner3:27 ↗
After implementing the academic RVU system, Nationwide had an increase in presentations, peer-reviewed publications, and external federal research funding.
host_summary3:44 ↗
External federal research funding at Nationwide increased from $750,000 to $5.7 million, representing a 7.7-fold increase.
host_summaryRod Gerardo3:58 ↗
At Akron Children's Hospital under Bob Perry, the bonus structure required the entire group to reach a certain RVU threshold for everyone to receive 50% of their bonus, eliminating competition for cases.
clinicalTodd Ponsky5:03 ↗
The BC Children's Hospital gastroschisis study was a retrospective review comparing outcomes before and after implementation of a protocol in 2012, covering patients from 2008 to 2019.
host_summary5:51 ↗
At Saint Justine Hospital, the approach to gastroschisis differed from other institutions in that there was very low use of silos, with pretty much every patient having an attempt at immediate bedside sutureless closure following a protocol developed several years prior.
clinicalCharza Jaharifard6:58 ↗
Before and after protocol implementation at BC Children's Hospital, approximately 75% of gastroschisis patients could be closed immediately, whether in the OR pre-implementation with fascial closure or at bedside post-implementation.
clinicalCharza Jaharifard7:57 ↗
With silo management, parents look at their newborn's intestines through a silo for 5-6 days and cannot hold their baby until the silo is completely reduced.
clinicalCharza Jaharifard8:27 ↗
With immediate closure of gastroschisis, if babies are extubated within 48 hours, parents can hold them within 48 hours, or immediately if managed without intubation.
clinicalCharza Jaharifard8:43 ↗
In prior studies of placental mesenchymal stem cells for in utero MMC repair, two surgeries were performed on lambs: one to create the defect and one to repair it, both in utero, with PMSCs used during repair.
host_summary10:17 ↗
In the current study, a single operation was performed at approximately 100 days gestational age where the MMC defect was created and repaired simultaneously, with PMSCs placed directly onto the spinal cord.
host_summary10:43 ↗
The PMSCs did not persist in the placentas, uteri, or lambs at 3 months follow-up.
host_summary11:23 ↗
There was no histological evidence of abnormal growth or tumor development in the ovine model at 3 months.
host_summary11:30 ↗
Human trials using PMSCs for in utero myelomeningocele repair have been initiated with the first two patients enrolled.
host_summary11:52 ↗
Fetal Surgical Intervention for Myelomeningocele: Fetal Surgery 2012
Spina bifida affects approximately 1500 babies born per year in the US, about 30 per week or 5-6 per day.
epidemiologicalScott Adzik82:06 ↗
With standard postnatal care, approximately 14% of MMC patients die by age 5, mostly due to symptomatic brain stem compression from hindbrain herniation.
clinicalScott Adzik83:20 ↗
About 85% of MMC patients require ventricular shunts with standard postnatal care, with approximately half developing shunt complications within one year.
clinicalScott Adzik83:33 ↗
The two-hit hypothesis for MMC proposes that secondary damage occurs in utero from amniotic fluid, meconium, or hydrodynamic forces after the initial failure of neurulation.
clinicalScott Adzik83:41 ↗
In fetal sheep models, mid-gestational spinal cord exposure leads to progressive neurologic injury that mimics human MMC, with paralysis and loss of sensation below the lesion level.
clinicalScott Adzik86:09 ↗
In utero coverage of experimentally created MMC in fetal sheep rescues neurologic function at birth, with lambs able to stand, walk, and maintain continence.
host_summaryScott Adzik86:43 ↗
Hindbrain herniation reverses after prenatal MMC repair because closing the defect prevents CSF leak, reestablishing the pressure column in the spinal canal.
clinicalScott Adzik90:15 ↗
In CHOP's pre-MOMS experience with 50 fetal MMC repairs, the shunt rate by one year was 40%, compared to 85% with postnatal repair.
clinicalScott Adzik93:10 ↗
Two-thirds of prenatally repaired MMC patients showed motor function two or more levels better than the anatomic lesion level.
clinicalScott Adzik93:41 ↗
The MOMS trial was stopped early on December 7, 2010 by the Data Safety Monitoring Board due to demonstrated efficacy of prenatal surgery.
clinicalScott Adzik102:18 ↗
In the MOMS trial, shunts were placed in 40% of the prenatal surgery group compared to 82% of the postnatal surgery group.
clinicalScott Adzik102:55 ↗
At 30 months, 42% of babies in the prenatal surgery group could walk independently versus only 21% in the postnatal surgery group.
clinicalScott Adzik103:31 ↗
Mean gestational age at delivery was 34 weeks in the prenatal surgery group versus 37 weeks in the postnatal group, with 13% of prenatal cases delivered before 30 weeks.
clinicalScott Adzik104:57 ↗
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