K Graf1, T Kohl2, B A Neubauer3, F Dey3, D Faas4, F A Wanis1, M H T Reinges1, E Uhl1, M A Kolodziej1. 1. Department of Neurosurgery, Justus-Liebig-University, Giessen, Germany. 2. German Center for Fetal Surgery & Minimally Invasive Therapy (DZFT), Justus-Liebig-University, Giessen, Germany. 3. Department of Neuropediatrics, Justus-Liebig-University, Giessen, Germany. 4. Department of General Pediatrics and Neonatology, Justus-Liebig-University, Giessen, Germany.
Abstract
OBJECTIVE: To evaluate the need for postnatal neurosurgical intervention after fetoscopic patch coverage of spina bifida aperta (SBA). METHODS: This was a retrospective analysis of a cohort of 71 fetuses which underwent minimally invasive fetoscopic patch coverage of SBA between 21 + 0 and 29 + 1 weeks of gestation. Postnatal neurosurgical procedures were classified into two types: re-coverage of the SBA within the first 3 months following birth, and shunt placement as treatment of associated hydrocephalus within the first year. RESULTS: Location of the SBA was lumbosacral in 59 cases, lumbar in seven, thoracic in three and sacral in two. In total, 20/71 (28%) patients underwent early postnatal neurosurgical intervention by means of re-coverage of the SBA. This was performed because of cerebrospinal fluid leakage in seven (35%), adhesions with functional deterioration in three (15%), incomplete coverage in five (25%) and skin defect in five (25%) cases. Ventriculoperitoneal shunt placement within 1 year was required in 32 (45%) cases and was preceded by ventriculostomy in two. Three (4%) infants needed Chiari decompression surgery in the first 12 months following birth, because of syringomyelia or gait disturbance. CONCLUSIONS: Fetoscopic patch coverage of SBA may require postnatal re-coverage in some cases. In most cases, conservative wound treatment shows good results, without requiring neurosurgical intervention. The low 1-year-shunt rate is comparable to data of the Management of Myelomeningocele Study and lower compared with published data of patients with postnatal only coverage of SBA.
OBJECTIVE: To evaluate the need for postnatal neurosurgical intervention after fetoscopic patch coverage of spina bifida aperta (SBA). METHODS: This was a retrospective analysis of a cohort of 71 fetuses which underwent minimally invasive fetoscopic patch coverage of SBA between 21 + 0 and 29 + 1 weeks of gestation. Postnatal neurosurgical procedures were classified into two types: re-coverage of the SBA within the first 3 months following birth, and shunt placement as treatment of associated hydrocephalus within the first year. RESULTS: Location of the SBA was lumbosacral in 59 cases, lumbar in seven, thoracic in three and sacral in two. In total, 20/71 (28%) patients underwent early postnatal neurosurgical intervention by means of re-coverage of the SBA. This was performed because of cerebrospinal fluid leakage in seven (35%), adhesions with functional deterioration in three (15%), incomplete coverage in five (25%) and skin defect in five (25%) cases. Ventriculoperitoneal shunt placement within 1 year was required in 32 (45%) cases and was preceded by ventriculostomy in two. Three (4%) infants needed Chiari decompression surgery in the first 12 months following birth, because of syringomyelia or gait disturbance. CONCLUSIONS: Fetoscopic patch coverage of SBA may require postnatal re-coverage in some cases. In most cases, conservative wound treatment shows good results, without requiring neurosurgical intervention. The low 1-year-shunt rate is comparable to data of the Management of Myelomeningocele Study and lower compared with published data of patients with postnatal only coverage of SBA.
Authors: Mano Shanmuganathan; Deborah A Sival; Kelly-Ann Eastwood; Katie Morris; Jacqueline Cartmill; Axel Heep; Janusz Bohosiewicz; Agnieszka Pastuszka; Alyson Hunter; Amanda Ali; Roy McConnell; Darach Crimmins; Fergal Malone; Carolyn Bailie; Jan Deprest; Cathy McKillop; Zarko Alfirevic; Fionnuala McAuliffe; Stephen Ong Journal: Ir J Med Sci Date: 2017-11-03 Impact factor: 1.568
Authors: Adolfo Etchegaray; Fernando Palma; Roberto De Rosa; Ricardo Daniel Russo; Ernesto Beruti; Rodolfo Fregonese; Hernán Allegrotti; Gabriel Musante; Angeles Cibert; Florencia Contino Storz; Sofia Marchionatti Journal: Surg Neurol Int Date: 2018-11-26
Authors: E Joanne Verweij; Martine C de Vries; Esther J Oldekamp; Alex J Eggink; Dick Oepkes; Femke Slaghekke; Jochem K H Spoor; Jan A Deprest; Jena L Miller; Ahmet A Baschat; Philip L J DeKoninck Journal: Prenat Diagn Date: 2021-04-05 Impact factor: 3.050