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- Title
Impact of the size of the lesion in prenatal neural tube defect repair on imaging, neurosurgical and motor outcomes: a retrospective cohort study.
- Authors
Corroenne, R; Zhu, KH; Johnson, E; Johnson, R; Whitehead, WE; Espinoza, J; Castillo, J; Castillo, H; Orman, G; Huisman, TAGM; Mehollin‐Ray, AR; Shamshirsaz, AA; Nassr, AA; Belfort, MA; Sanz Cortes, M; Zhu, K H; Whitehead, W E; Mehollin-Ray, A R; Shamshirsaz, A A; Nassr, A A
- Abstract
<bold>Objectives: </bold>(1) To compare brain findings between large and non-large neural tube defect (NTD); (2) to evaluate the impact of large lesion on the surgical parameters; (3) to study any associations between the size of the lesions and brain findings 6 weeks postoperatively and neurological short-term outcomes.<bold>Design: </bold>Retrospective cohort study.<bold>Setting: </bold>Texas Children's Hospital, between 2011 and 2018.<bold>Population: </bold>Patients who underwent prenatal NTD repair.<bold>Methods: </bold>Large lesion was defined when the lesion's surface was >75th centile of our cohorts' lesions.<bold>Main Outcome Measures: </bold>Time of referral: ventriculomegaly and anatomical level of the lesion; surgery: duration and need for relaxing incisions. 6 weeks postoperative: hindbrain herniation (HBH) and ventriculomegaly. After delivery: dehiscence, need for hydrocephalus treatment and motor function.<bold>Results: </bold>A total of 99 patients were included, 25 of whom presented with large lesions. Type of lesion and ventriculomegaly were comparable between individuals with large and non-large lesions. Individuals with large lesions were associated with increased need for relaxing incisions by 5.4 times (95% CI 1.3-23.2, P = 0.02). Six weeks postoperatively, having a large lesion decreased by ten times the likelihood of having a postoperative reversal of HBH (odds ratio = 0.1, 95% CI 0.1-0.4, P < 0.01). At birth, larger lesions increased the risk for repair dehiscence by 6.1 times (95% CI 1.6-22.5, P < 0.01) and the risk of dehiscence or leakage of cerebrospinal fluid at birth by 5.5 times (95% CI 1.6-18.9, P < 0.01).<bold>Conclusion: </bold>Prenatal repair of patients with large NTD presents a lower proportion of HBH reversal 6 weeks after the surgery, a higher risk of dehiscence and a higher need for postnatal repair.<bold>Tweetable Abstract: </bold>Evaluation of the size of fetal NTD can predict adverse neurological outcomes after prenatal NTD repair.
- Subjects
NEURAL tube defects; COHORT analysis; CHILDREN'S hospitals; FETAL surgery; CEREBROSPINAL fluid; BRAIN damage; NEUROLOGIC examination; FETOSCOPY; OBSTETRICS surgery; PRENATAL diagnosis; MAGNETIC resonance imaging; RETROSPECTIVE studies; FETAL diseases; TREATMENT effectiveness; MOTOR ability
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2021, Vol 128, Issue 2, p392
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.16316