Presurgery motor level assessment for prediction of motor level at birth in fetuses undergoing prenatal repair of open spina bifida: time to abandon anatomical level in counseling

Maíz, Nerea; Arévalo, Sílvia; Garcia‐Manau, Pablo; Melendez, Mar; Giné, C; Rodó, Carlota; López, María Laura; Carreras, Elena

doi:10.1002/uog.26180

Cited by 6 publications

(6 citation statements)

References 17 publications

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“…Our results are in agreement those of a recent study published by Maiz et al 5 . Anatomical level of the lesion and postnatal motor-function level were concordant in only 23% of cases and, comparing prenatal and postnatal motor-function levels, we found that 87% of infants presented similar or improved motor-function level in the postnatal evaluation.…”

Section: Review In Context Of Previous Studiessupporting

confidence: 94%

“…Anatomical level of the lesion and postnatal motor‐function level were concordant in only 23% of cases and, comparing prenatal and postnatal motor‐function levels, we found that 87% of infants presented similar or improved motor‐function level in the postnatal evaluation. Similarly, Maiz et al 5 . reported 88.5% of cases with similar and 1.9% of cases with improved postnatal motor‐function level.…”

Section: Discussionmentioning

confidence: 77%

“…Similar results were found by an international consortium for fetoscopic repair of OSB in a study that included 300 cases 4 : only 19% (49/257) of infants had a concordant anatomical level and postnatal motor function. Recently, Maiz et al 5 found similar results in a prospective trial, reporting moderate agreement of fetal motor level of the lesion before prenatal repair of OSB, but only slight agreement of presurgery anatomical level, with motor level at birth. This evidence raises the question as to whether lower-extremity neurological motor-function level assessed by prenatal ultrasound should be used in counseling patients who are considering prenatal repair of OSB.…”

Section: Introductionmentioning

confidence: 70%

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Revisiting MOMS criteria for prenatal repair of spina bifida: upper gestational‐age limit should be raised and assessment of prenatal motor function rather than anatomical level improves prediction of postnatal function

Trigo,

Chmait,

Llanes

et al. 2024

Ultrasound in Obstet & Gyne

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ObjectivesTo determine if the lower extremity motor function of a fetus with open spina bifida deteriorates within a four‐week interval between their first prenatal motor assessment at 22 weeks of gestation and second presurgical evaluation in cases operated at later gestational age (26‐27 weeks of gestation), and to compare prenatal and postnatal motor function to the anatomical level of the lesion.MethodsMulticenter cohort study involving cases from two centers that perform percutaneous fetoscopic repair of open spina bifida (SAFER technique). 94 fetuses with open spina bifida underwent two prenatal ultrasound evaluations before fetal surgery in approximately a four‐week interval, and one postnatal evaluation within two months of birth. Motor function classification was performed according to key muscle function from L1 to S1. Prenatal assessments were performed systematically by ultrasound at the first visit and the second evaluation occurring before fetoscopic repair. Postnatal evaluation was done via physical examination within the first two months of life. Each leg was analyzed individually; in case of discrepancy between the two legs, the worst level was considered for analysis. All motor level evaluations were compared to the anatomical level. Independent factors to a postnatal motor function reduction were assessed using a logistic regression model.ResultsPrenatal motor level was assessed at 22.5 (20.7‐24.3) and at 26.9 (25.4‐27.3) weeks’ gestation, with a median interval of 4 (2.4‐6.0) weeks. Median gestational age at surgery was 27 (25.6‐27.6) weeks. No significant difference in motor function was found between both prenatal evaluations (p=0.861). All prenatal and postnatal motor function evaluations were significantly different from the anatomical level (1st preoperative assessment, p=0.0023; 2nd preoperative assessment, p=0.0015; postnatal assessment, p=0.0333). Comparing prenatal versus postnatal motor function, we found almost 90% of babies maintained or improved motor function as compared to pre‐surgery level. In the logistic regression, lower anatomical level and higher difference between anatomical and motor level were found as independent factors for postnatal motor function (OR 0.237, p=0.002; and OR 3.44, p<0.001, respectively).ConclusionsThe 4‐week interval between the first evaluation and the “late” fetal surgical repair does not significantly change motor function, suggesting that later repair > 26 weeks does not have a negative impact on motor outcome. The preoperative neuromotor functional assessment via ultrasound was better predictive of postnatal motor function as compared to the anatomical level of the lesion in cases undergoing prenatal repair of open spina bifida and should be included in preoperative counseling.This article is protected by copyright. All rights reserved.

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Section: Review In Context Of Previous Studiessupporting

confidence: 94%

Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 70%

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Revisiting MOMS criteria for prenatal repair of spina bifida: upper gestational‐age limit should be raised and assessment of prenatal motor function rather than anatomical level improves prediction of postnatal function

Trigo,

Chmait,

Llanes

et al. 2024

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

show abstract

“…29 Ultrasound assessment of motor function was qualified according to the lower extremity movements: Level L1 corresponds to hip flexion, L2 corresponds to hip adduction, L3 corresponds to the knee extension, L4 to knee flexion, L5 to dorsal flexion of the ankle and S1 to plantar flexion of the ankle. 30 Evaluation of the posterior fossa on fetal MRI included clivussupraocciput angle (CSA) as published by Woitek et al, presence of hindbrain herniation below the foramen magnum (FM), presence of cerebellar towering, clival concavity, brainstem compression, and tectal beaking. 31 In addition, the presence of a banana sign in the suboccipital bregmatic view was analyzed on prenatal US.…”

Section: Methodsmentioning

confidence: 99%

“…Prenatal functional US was performed as previously published, including evaluation for abnormal foot position 29 . Ultrasound assessment of motor function was qualified according to the lower extremity movements: Level L1 corresponds to hip flexion, L2 corresponds to hip adduction, L3 corresponds to the knee extension, L4 to knee flexion, L5 to dorsal flexion of the ankle and S1 to plantar flexion of the ankle 30 …”

Section: Methodsmentioning

confidence: 99%

Prenatal diagnosis and postnatal outcome of closed spinal dysraphism

Bedei,

Krispin,

Sanz Cortes

et al. 2023

Prenatal Diagnosis

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ObjectiveTo evaluate the prenatal diagnosis of closed dysraphism (CD) and its correlation with postnatal findings and neonatal adverse outcomes.MethodsA retrospective cohort study including pregnancies diagsnosed with fetal CD by prenatal ultrasound (US) and magnetic resonance imaging (MRI) at a single tertiary center between September 2011 and July 2021.ResultsCD was diagnosed prenatally and confirmed postnatally in 12 fetuses. The mean gestational age of prenatal imaging was 24.2 weeks, in 17% the head circumference was ≤fifth percentile and in 25% the cerebellar diameter was ≤fifth percentile. US findings included banana sign in 17%, and lemon sign in 33%. On MRI, posterior fossa anomalies were seen in 33% of cases, with hindbrain herniation below the foramen magnum in two cases. Mean clivus‐supraocciput angle (CSA) was 74°. Additional anomalies outside the CNS were observed in 50%. Abnormal foot position was demonstrated prenatally in 17%. Neurogenic bladder was present in 90% of patients after birth.ConclusionArnold Chiari II malformation and impaired motor function can be present on prenatal imaging of fetuses with CD and may be associated with a specific type of CD. Prenatal distinction of CD can be challenging. Associated extra CNS anomalies are frequent and the rate of neurogenic urinary tract dysfunction is high.

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Proposal for standardized prenatal assessment of fetal open dysraphisms by the European reference network for Intellectual disability, TeleHealth, Autism and Congenital Anomalies (ITHACA) and eUROGEN

Guilbaud,

Carreras,

Garel

et al. 2024

Prenatal Diagnosis

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Open dysraphisms, that is, myelomeningocele and myeloschisis, are rare diseases associated with a risk of severe disability, including lower limb motor and sensory deficiency, sphincter deficiency, and potential intellectual deficiency. Open dysraphism is diagnosed in Europe in 93.5% of cases. In case of suspicion of fetal open dysraphism, a detailed fetal morphologic assessment is required to confirm the diagnosis and exclude associated structural anomalies, as well as genetic assessment. In case of isolated fetal open dysraphism, assessment of prognosis is based on fetal imaging including the level of the lesion, the presence or not of a sac, the presence and nature of intra cranial anomalies, and the anatomical and functional evaluation of the lower extremities. Based on these biomarkers, a personalized prognosis as well as comprehensive information about prenatal management alternatives will allow parents to decide on further management options. Standardization of prenatal assessment is essential to compare outcomes with benchmark data and make assessment of surgical innovation possible. Herein, we propose a protocol for the standardized ultrasound assessment of fetuses with isolated open dysraphism.

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Presurgery motor level assessment for prediction of motor level at birth in fetuses undergoing prenatal repair of open spina bifida: time to abandon anatomical level in counseling

Cited by 6 publications

References 17 publications

Revisiting MOMS criteria for prenatal repair of spina bifida: upper gestational‐age limit should be raised and assessment of prenatal motor function rather than anatomical level improves prediction of postnatal function

Revisiting MOMS criteria for prenatal repair of spina bifida: upper gestational‐age limit should be raised and assessment of prenatal motor function rather than anatomical level improves prediction of postnatal function

Prenatal diagnosis and postnatal outcome of closed spinal dysraphism

Proposal for standardized prenatal assessment of fetal open dysraphisms by the European reference network for Intellectual disability, TeleHealth, Autism and Congenital Anomalies (ITHACA) and eUROGEN

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