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

Objectives (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 o...

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Bibliographic Details
Published in:BJOG : an international journal of obstetrics and gynaecology 2021-01, Vol.128 (2), p.392-399
Main 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
Format: Article
Language:English
Subjects:
Birth defects
Cerebrospinal fluid
Cohort analysis
Congenital diseases
Dehiscence
Female
Fetal Diseases - diagnostic imaging
Fetal Diseases - pathology
Fetal Diseases - surgery
Fetal surgery
Fetoscopy
Fetuses
Hindbrain
Humans
Hydrocephalus
Hysterotomy
Infant, Newborn
Lesions
Magnetic Resonance Imaging
Male
Motor Activity - physiology
myelomeningocele
myeloschisis
neural tube defect
Neural Tube Defects - diagnostic imaging
Neural Tube Defects - pathology
Neural Tube Defects - surgery
Neuroimaging
Neurosurgery
Patients
Pregnancy
Prenatal Diagnosis
Retrospective Studies
spina bifida
Surgery
Treatment Outcome
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Summary:Objectives (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. Design Retrospective cohort study. Setting Texas Children’s Hospital, between 2011 and 2018. Population Patients who underwent prenatal NTD repair. Methods Large lesion was defined when the lesion’s surface was >75th centile of our cohorts’ lesions. Main outcome measures 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. Results 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 
ISSN:1470-0328
1471-0528
DOI:10.1111/1471-0528.16316