Roland Zimmermann1,2,3, Martin Meuli4,1,5,3, Ueli Moehrlen6,7,8,9, Nicole Ochsenbein1,2,3, Ladina Vonzun1,2, Luca Mazzone4,1,10,5, Maya Horst4,10,5, Sonja Schauer4,10,5, David Alexander Wille11,10,5, Cornelia Hagmann12,5, Raimund Kottke13,5, Patrice Grehten13,5, Barbara Casanova4,1,5, Nele Strübing1,2, Theres Moehrlen4,1,5, Sasha Tharakan4,1,5, Beth Padden14,10,5, Dirk Bassler15,3. 1. The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland. 2. Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland. 3. University of Zurich, Zurich, Switzerland. 4. Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland. 5. Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland. 6. Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland. ueli.moehrlen@kispi.uzh.ch. 7. The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland. ueli.moehrlen@kispi.uzh.ch. 8. Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland. ueli.moehrlen@kispi.uzh.ch. 9. University of Zurich, Zurich, Switzerland. ueli.moehrlen@kispi.uzh.ch. 10. Zurich Center for Spina Bifida, University Children's Hospital Zurich, Zurich, Switzerland. 11. Division of Pediatric Neurology, University Children's Hospital Zurich, Zurich, Switzerland. 12. Division of Intensive Care and Neonatology, University Children' Hospital Zurich, Zurich, Switzerland. 13. Division of Diagnostic Imaging, MR-Center, University Children's Hospital Zurich, Zurich, Switzerland. 14. Division of Pediatric Rehabilitation, University Children's Hospital Zurich, Zurich, Switzerland. 15. Department of Neonatology, University Hospital Zurich, Zurich, Switzerland.
Abstract
PURPOSE: Over the past 10 years, over 150 fetal spina bifida surgeries were performed at the Zurich Center for Fetal Diagnosis and Therapy. This study looks at surrogates for success and failure of this approach. METHODS: We focused on key outcome parameters including hydrocephalus shunt rate at one year, bladder control at 4, independent ambulation at 3 years, and maternal, fetal, and neonatal complications. RESULTS: From the first 150 patients undergoing fetal surgery for spina bifida, 148 (98.7%) were included in the study. Maternal-fetal surgery was uneventful in 143/148 (97%) cases. Intraoperative problems included resuscitation in 4/148 fetuses (2.7%). 1/148 fetuses (0.7%) died on postoperative day 4. Maternal complications included chorioamniotic membrane separation in 22/148 (15%), lung embolism in 3/148 (2.1%), chorioamnionitis in 2/148 (1.4%), AV-block III and uterine rupture in 1/148 each (0.7%). 1/148 (0.7%) newborn death was recorded. Hindbrain herniation was identified preoperatively in 132/148 (90%) fetuses and resolved completely in 119/132 (90%). At one year, 39/106 (37%) children had required a CSF diversion. At 4 years, 4/34 patients (12%) had normal bladder control. At 3 years, 48/57 (84%) walked independently. CONCLUSION: A majority of patients benefitted from prenatal intervention, in that the shunt rate was lower and the rates of continent and walking patients were higher than reported with postnatal care.
PURPOSE: Over the past 10 years, over 150 fetal spina bifida surgeries were performed at the Zurich Center for Fetal Diagnosis and Therapy. This study looks at surrogates for success and failure of this approach. METHODS: We focused on key outcome parameters including hydrocephalus shunt rate at one year, bladder control at 4, independent ambulation at 3 years, and maternal, fetal, and neonatal complications. RESULTS: From the first 150 patients undergoing fetal surgery for spina bifida, 148 (98.7%) were included in the study. Maternal-fetal surgery was uneventful in 143/148 (97%) cases. Intraoperative problems included resuscitation in 4/148 fetuses (2.7%). 1/148 fetuses (0.7%) died on postoperative day 4. Maternal complications included chorioamniotic membrane separation in 22/148 (15%), lung embolism in 3/148 (2.1%), chorioamnionitis in 2/148 (1.4%), AV-block III and uterine rupture in 1/148 each (0.7%). 1/148 (0.7%) newborn death was recorded. Hindbrain herniation was identified preoperatively in 132/148 (90%) fetuses and resolved completely in 119/132 (90%). At one year, 39/106 (37%) children had required a CSF diversion. At 4 years, 4/34 patients (12%) had normal bladder control. At 3 years, 48/57 (84%) walked independently. CONCLUSION: A majority of patients benefitted from prenatal intervention, in that the shunt rate was lower and the rates of continent and walking patients were higher than reported with postnatal care.