Impact of the size of the lesion in prenatal neural tube defect repair on imaging, neurosurgical and motor outcomes: a retrospective cohort study

Corroënne, Romain; Zhu, Katherine; Johnson, Emily; Johnson, R.C.; Whitehead, William E.; Espinoza, Jimmy; Castillo, Jonathan; Castillo, Heidi; Orman, Güneş; Huisman, T. A. G. M.; Mehollin-Ray, Amy R.; Shamshirsaz, Amir A.; Belfort, Michael A.; Cortes, M. Sanz

doi:10.1111/1471-0528.16316

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…When considering the spinal defect characteristics, changes in the posterior fossa structures worsened in the presence of higher lesions and the presence of a flat rather than cystic lesion, and, consequently, wider ventricles. This observation is in line with previous studies that described a higher prevalence of severe CM-II in MS 42 , and that higher and larger lesions display a lower reduction in hindbrain herniation after prenatal repair 43 .…”

Section: Discussionsupporting

confidence: 93%

Prevalence of supratentorial anomalies assessed by magnetic resonance imaging in fetuses with open spina bifida

Trigo

Eixarch

Bottura³

et al. 2022

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?This study demonstrates that half of fetuses eligible for prenatal open spina bifida repair have structural brain anomalies, such as an abnormal corpus callosum or heterotopia. Such anomalies were more likely in the presence of a lumbar or higher lesion and wider lateral ventricles (≥ 15 mm). What are the clinical implications of this work?Our findings highlight the relevance of detailed prenatal and preoperative assessment of the brain in fetuses with open spina bifida. One can expect that around half of affected fetuses will present with central nervous system anomalies prior to fetal surgery, which may be considered as additional information for presurgical counseling.

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Section: Discussionsupporting

confidence: 93%

Prevalence of supratentorial anomalies assessed by magnetic resonance imaging in fetuses with open spina bifida

Trigo

Eixarch

Bottura³

et al. 2022

Ultrasound in Obstet & Gyne

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“…Spherical shape of the split, together with a small, flat hernia sack or no hernia sack, creates a favorable environment for TCS. Such conditions usually impede complete untethering of the neural structures and a full three-layer reconstruction of normal anatomy [ 23 ]. Technical challenges associated with the procedure result from changes in the dural structure and chronic inflammation of the subarachnoid space due to severe tissue adhesion.…”

Section: Discussionmentioning

confidence: 99%

Fetoscopic Myelomeningocele Repair with Complete Release of the Tethered Spinal Cord Using a Three-Port Technique: Twelve-Month Follow-Up—A Case Report

et al. 2022

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Open spina bifida is one of the most common congenital defects of the central nervous system. Open fetal surgery, which is one of the available therapeutic options, remains the gold standard for prenatal repairs. Fetoscopic closure may lower the number of maternal complications associated with open fetal surgery. Regardless of the approach, the outcome may be compromised by the development of tethered spinal cord (TSC) syndrome. At 24.2 weeks of gestation, a primipara was admitted due to fetal myelomeningocele and was deemed eligible for fetoscopic repair. Fetal surgery was performed at 25.0 weeks of gestation. It was the first complete untethering of the spinal cord and anatomic reconstruction (dura mater, spinal erectors, skin) achieved during a fetoscopic repair of spina bifida. Cesarean section due to placental abruption was performed at 31.1 weeks of gestation. VP shunting, with no need for revision, was performed at 5 weeks postdelivery due to progressing ventriculomegaly. No clinical or radiological signs of secondary tethering were observed. Neurological examination at 11 months postdelivery revealed cranial nerves without any signs of damage, axial hypotonia, decreased muscle tone in the lower extremities, and absent pathological reflexes. Motor development was slightly retarded. Complete untethering of the neural structures should always be performed, regardless of the surgical approach, as it is the only course of action that lowers the risk for developing secondary TSC.

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“…Once the shunt is in place, they may need repeated procedures such as shunt revisions when the child grows, or because of infection, blockage, or any malfunction. The size of the defect may determine the adverse outcome as well (Corroenne et al, 2021).…”

Section: Methodsmentioning

confidence: 99%

“…In-utero surgery to close the external lesion of SB is a parental choice, and the surgery is done after informed consent and maternal medications to prevent labor induction (Corroenne et al, 2021; Rimbos, 2023). Fetoscopic or open repair through an open hysterotomy for large lesions may be performed, and the baby will be followed up at birth.…”

Section: Methodsmentioning

confidence: 99%

Needs of Parents of Children With Spina Bifida

Joseph¹

2022

Journal of Pediatric Surgical Nursing

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Spina bifida (SB) is a birth defect involving the neural tube of the spine. The severity of the condition depends on the extent of the defect. The most severe cases of SB are debilitating and can significantly affect the quality of life of babies born with the defect.Complications of SB can include mobility issues, orthopedic abnormalities, elimination impairments, infections, cognitive delays, and frequent hospitalizations, and these can span the lifetime of the child. The complications and needs associated with SB become very specific as the child reaches adulthood. According to the Centers for Disease Control and Prevention, approximately one in every 2,758 babies born annually in the United States are diagnosed with SB. Learning that a child will be born with a birth defect can be devastating for parents. Several decisions need to be made at birth and as the child grows. Many parents facing such news are overwhelmed and experience a range of emotions. The needs of parents caring for children with SB will vary based on their understanding of the disease process, ability to access resources, availability of a support system, and the capacity to cope with the challenges that arise when caring for a child born with this condition. Nurses must be diligent in exploring the needs of this parent population. This article is intended to raise awareness among nurses regarding parental needs so that they can support and assist parents in developing more effective ways to navigate through their journey.

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Impact of the size of the lesion in prenatal neural tube defect repair on imaging, neurosurgical and motor outcomes: a retrospective cohort study

Cited by 7 publications

References 19 publications

Prevalence of supratentorial anomalies assessed by magnetic resonance imaging in fetuses with open spina bifida

Prevalence of supratentorial anomalies assessed by magnetic resonance imaging in fetuses with open spina bifida

Fetoscopic Myelomeningocele Repair with Complete Release of the Tethered Spinal Cord Using a Three-Port Technique: Twelve-Month Follow-Up—A Case Report

Needs of Parents of Children With Spina Bifida

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