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- Title
Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta. Part III: neurosurgical intervention in the first postnatal year.
- Authors
Graf, K.; Kohl, T.; Neubauer, B. A.; Dey, F.; Faas, D.; Wanis, F. A.; Reinges, M. H. T.; Uhl, E.; Kolodziej, M. A.
- Abstract
<bold>Objective: </bold>To evaluate the need for postnatal neurosurgical intervention after fetoscopic patch coverage of spina bifida aperta (SBA).<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
FETAL surgery; SPINA bifida; HYDROCEPHALUS; NEUROSURGERY; CEREBROSPINAL fluid; SYRINGOMYELIA; THERAPEUTICS; BACK; CEREBROSPINAL fluid shunts; FETOSCOPY; GESTATIONAL age; POSTNATAL care; REOPERATION; RETROSPECTIVE studies; DISEASE complications; SURGERY
- Publication
Ultrasound in Obstetrics & Gynecology, 2016, Vol 47, Issue 2, p158
- ISSN
0960-7692
- Publication type
journal article
- DOI
10.1002/uog.14937