Impact of the size of the lesion in prenatal neural tube defect repair on imaging, neurosurgical and motor outcomes: a retrospective cohort study.
Fetal surgery
fetoscopy
myelomeningocele
myeloschisis
neural tube defect
spina bifida
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
accepted:
28
04
2020
pubmed:
15
5
2020
medline:
5
3
2021
entrez:
15
5
2020
Statut:
ppublish
Résumé
(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. Retrospective cohort study. Texas Children's Hospital, between 2011 and 2018. Patients who underwent prenatal NTD repair. Large lesion was defined when the lesion's surface was >75th centile of our cohorts' lesions. 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. 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). 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. Evaluation of the size of fetal NTD can predict adverse neurological outcomes after prenatal NTD repair.
Identifiants
pubmed: 32406575
doi: 10.1111/1471-0528.16316
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
392-399Subventions
Organisme : O'quinn foundation
Organisme : fondren foundation
Organisme : Tramuto foundation
Organisme : Sterling-Turner Foundation
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 Royal College of Obstetricians and Gynaecologists.
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