Antenatal management of fetal neurosurgical diseases

Abstract

The advance in the imaging tools during the pregnancy (ultrasound and magnetic resonance) allowed the early diagnose of many fetal diseases, including the neurological conditions. This progress brought the neurosurgeons the possibility to propose treatments even before birth. Myelomeningocele is the most recognized disease that can be treated during pregnancy with a high rate of success. Additionally, this field can be extended to other conditions such as hydrocephalus and encephaloceles. However, each one of these diseases has nuances in the diagnostic evaluation that should fit the requirements to perform the fetal procedure and overbalance the benefits to the patients. In this article, the authors aim to review the neurosurgical aspects of the antenatal management of neurosurgical conditions based on the experience of a pediatric neurosurgery center.

Perinatal outcomes after open fetal surgery for myelomeningocele repair: a retrospective cohort study

“…In all cases, the skin could be closed, and the healing process was effective without the use of exogenous material. 15 …”

A large posterior encephalocele associated with severe ventriculomegaly, cerebellar atrophy and transposition of the great arteries

“…Large amounts of neuronal tissue inside the defect are generally associated with microcephaly. Hydrocephalus and microcephalus are the most critical risk factors . It has been reported that the encephalocele defects located on the occipital region have a worse prognosis than those developed in the frontal region .…”

“…Encephalocele is a cranial bone defect, which is characterized by protrusion of the meninges and/or neural tissue through the defect . This sac‐like protrusion is covered by skin.…”

“…One third of these patients die and 76% of deaths occur in the first day after birth. Half of the patients who live beyond the first day have various degrees of neurodevelopmental delays . Occipital encephaloceles may be accompanied by other congenital abnormalities including of the central nervous system.…”

Cerebellar herniation demonstrated by the occipitum‐dens line: Ultrasonography assessment of normal fetuses, fetuses with myelomeningocele, and fetuses that underwent antenatal myelomeningocele surgery

“…This protocol follows the same recommendations with regard to the criteria for screening patients, preoperative evaluation protocol, and postoperative care, with an exception for the opening and closure of the uterus due to the legal impediment in our country which precludes the use of a uterine stapler without being licensed by a governmental agency. This impediment forced us to develop an alternative surgical technique …”