Ultrasound Obstet Gynecol. 2021 Apr 20. doi: 10.1002/uog.23658. Online ahead of print.
ABSTRACT
BACKGROUND: A trial comparing prenatal with postnatal open spina bifida (OSB) repair established that prenatal surgery was associated with better postnatal outcome. However, in the trial the fetal surgery was carried out through hysterotomy. Minimally invasive approaches are being developed to mitigate the risks of open maternal fetal surgery.
OBJECTIVE: To investigate the impact of a novel neurosurgical technique for repair of feta; OSB, the skin-over-biocellulose for antenatal fetoscopic repair (SAFER) via percutaneous fetoscopy, on long-term postnatal outcomes.
STUDY DESIGN: Descriptive data for all patients undergoing fetoscopic OSB repair and available 12- and 30-month follow-up for assessment of need for cerebrospinal fluid (CSF) diversion and bladder catheterization and ambulation, respectively. A total of 170 consecutive patient s were treated prenatally at eight centers via percutaneous fetoscopic OSB repair using a biocellulose patch between the neural placode and skin/myofascial flap, without suture of the duramater. A total of 103 babies had follow-up at 12 months of age and 59 had follow-up at 30 months of age. Univariate and multivariate logistic regression analysis was used to examine the effect on CSF diversion at 12 months, and ambulation and bladder catheterization at 30 months. Potential co-factors were gestational age at fetal surgery and delivery, preoperative ultrasound findings of anatomical level of the lesion, cerebral lateral ventricle diameter, lesion type and presence of bilateral talipes, as well as postnatal findings of CSF leak at birth, motor level, bilateral talipes and reversal of hindbrain herniation. Significance was set at p<0.05.
RESULTS: At 12-months of age 53.4% (55/103) of babies did not require ventriculoperitoneal shunt or third ventriculostomy. At 30-months of ag e, 54.2% (32/59) of the children were ambulating independently and 61% (36/59) did not require chronic intermittent catheterization of the bladder. Multiple logistic regression analysis demonstrated that significant prediction for CSF diversion was provided by anatomical and functional motor level of the lesion, lateral ventricle size and type of lesion (myeloschisis). Significant predictors of ambulatory status were prenatal bilateral talipes and anatomical and functional motor level of the lesion. There were no significant predictors for the need of bladder catheterization.
CONCLUSION: Children that underwent prenatal OSB repair via the percutaneous fetoscopic SAFER technique achieved long-term neurological outcomes similar to those reported in the literature after hysterotomy-assisted OSB repair. This article is protected by copyright. All rights reserved.
PMID:33880811 | DOI:10.1002/uog.23658
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