Effects of birth advancement in Chiari malformation in a surgical myelomeningocele model in rabbits

Abstract Background/Purpose In myelomeningocele (MMC), Chiari II malformation progresses during gestation because of the continuous loss of cerebrospinal fluid at the site of the defect. Our purpose was to assess the impact of birth advancement (BA) and prenatal corticosteroid treatment (PCT) on Chi...

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Bibliographic Details
Published in:Journal of pediatric surgery 2010-03, Vol.45 (3), p.594-599
Main Authors: Fontecha, Cesar G, Aguire, Marius, Soldado, Francisco, Peiro, Jose L, Toran, Nuria, Vidal, Nuria, Martinez, Vicente
Format: Article
Language:English
Subjects:
Animals
Animals, Newborn
Arnold-Chiari Malformation - drug therapy
Arnold-Chiari Malformation - etiology
Arnold-Chiari Malformation - physiopathology
Betamethasone - pharmacology
Cerebellum - pathology
Confidence Intervals
Disease Models, Animal
Female
Fetal Diseases - mortality
Fetal Diseases - surgery
Fetal Mortality
Fetal therapy
Gestational Age
Meningomyelocele - complications
Meningomyelocele - mortality
Meningomyelocele - surgery
Neural tube defect
Pediatrics
Pregnancy
Probability
Rabbit
Rabbits
Surgery
Treatment Outcome
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Summary:Abstract Background/Purpose In myelomeningocele (MMC), Chiari II malformation progresses during gestation because of the continuous loss of cerebrospinal fluid at the site of the defect. Our purpose was to assess the impact of birth advancement (BA) and prenatal corticosteroid treatment (PCT) on Chiari malformation in a surgical MMC model in rabbits. Methods A surgical MMC-like defect was created in 75 fetal rabbits. Animals were distributed into 4 groups depending on the treatment received: not treated and those undergoing BA + PCT, BA, or PCT. The degree of Chiari malformation in newborn rabbits was defined as the percentage of downward protrusion of the hindbrain between the end of the occipital bone and the beginning of the first vertebral arch. Results The degree of hindbrain herniation was 80% (8.15) in the not treated group, 36.8% (10.57) in BA + PCT, 41.8% (8.27) in BA, and 44.4% (8.32) in PCT. The BA + PCT, BA, and PCT groups showed less severe hindbrain herniation than not treated animals (mean decrease, 39.86%; SD, 10.57; P = .000). There were no significant differences between the BA + PCT, BA, and PCT groups ( P = .311). Conclusions Birth advancement and prenatal administration of corticosteroids decrease the severity of the hindbrain herniation component of Chiari II malformation in surgical MMC in fetal rabbits.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2009.08.003