Acquired spinal cord injury in human fetuses with myelomeningocele

Grover M. Hutchins, Martin Meuli, Mary Ann Jordan, Dan S. Heffez, Karin Blakemore

Research output: Contribution to journalArticle

Abstract

Experimental studies have shown that there is a potential to attempt in utero repair of myelomeningocele in human fetuses. To provide a better understanding of the pathology of these lesions we prospectively studied eight stillborn human fetuses with myelomeningocele autopsied at The Johns Hopkins Hospital. The intact vertebral column with surrounding structures was removed, processed as a single block, and prepared as serial histologic sections. Study of the slides showed in all cases that in the center of the myelomeningocele the vertebral arch was open, the arrangement of meninges was such that the dura mater was open and in continuity with the deep layers of the dermis, and the pia mater was open and in continuity with a layer consisting of the superficial dermis and the epidermis. These meningeal relationships created an abnormally configured arachnoid space containing cerebrospinal fluid ventral to the spinal cord, which rested on the open pia mater and was exposed on the dorsal aspect of the sac. At the level of the myelomeningocele the naked cord had undergone varying degrees of injury up to complete loss of neural tissue. Where ventral remnants of the cord remained it was evident that a large degree of normal development of the cord had occurred. In most instances it appeared that the injury or destruction of the dorsal spinal cord was recent and consistent with occurrence during delivery. The results of this study support the concept that in utero surgery could preserve and protect the exposed spinal cord in a myelomeningocele of a human fetus and thus could reduce the severity of the neurologic deficit at birth.

Original languageEnglish (US)
Pages (from-to)701-712
Number of pages12
JournalPediatric Pathology and Laboratory Medicine
Volume16
Issue number5
DOIs
StatePublished - 1996

Fingerprint

Meningomyelocele
Spinal Cord Injuries
Fetus
Pia Mater
Spinal Cord
Dermis
Arachnoid
Meninges
Dura Mater
Wounds and Injuries
Neurologic Manifestations
Epidermis
Cerebrospinal Fluid
Spine
Parturition
Pathology

Keywords

  • autopsy
  • birth injury
  • dysraphia
  • fetal surgery
  • meninges
  • myelomeningocele

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Acquired spinal cord injury in human fetuses with myelomeningocele. / Hutchins, Grover M.; Meuli, Martin; Jordan, Mary Ann; Heffez, Dan S.; Blakemore, Karin.

In: Pediatric Pathology and Laboratory Medicine, Vol. 16, No. 5, 1996, p. 701-712.

Research output: Contribution to journalArticle

Hutchins, Grover M. ; Meuli, Martin ; Jordan, Mary Ann ; Heffez, Dan S. ; Blakemore, Karin. / Acquired spinal cord injury in human fetuses with myelomeningocele. In: Pediatric Pathology and Laboratory Medicine. 1996 ; Vol. 16, No. 5. pp. 701-712.
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