Nagaraj U D, Bierbrauer K S, Zhang B, Peiro J L, Kline-Fath B M
University of Cincinnati College of Medicine (U.D.N., K.S.B., B.Z., J.L.P., B.M.K.-F.), Cincinnati, Ohio.
Department of Pediatric Neurosurgery (K.S.B.).
AJNR Am J Neuroradiol. 2017 May;38(5):1031-1036. doi: 10.3174/ajnr.A5116. Epub 2017 Mar 9.
As the practice of in utero repair of myelomeningoceles becomes more prevalent, knowledge of the expected MR imaging findings has become increasingly important. Our aim was to examine neuroimaging findings with a focus on hindbrain herniation and ventricular size in fetuses with open spinal dysraphism and to compare them with postnatal imaging features in groups undergoing prenatal-versus-postnatal repair.
Single-center retrospective analysis was performed on MRIs of fetuses with open spinal dysraphism from January 2004 through July 2015 with available postnatal imaging. One hundred two fetuses were included. Reports from available fetal ultrasound were also examined. Images were reviewed by 2 board-certified fellowship-trained pediatric neuroradiologists. Descriptive analyses were performed to demonstrate the distribution of the imaging findings.
Thirty-two of 102 (31.3%) fetuses underwent in utero repair of open spinal dysraphism; 68.6% (70/102) underwent postnatal repair. Ninety-four of 102 (92.2%) fetuses had cerebellar ectopia. Of those who underwent prenatal repair (26 grade 3, 6 grade 2), 81.3% (26/32) had resolved cerebellar ectopia postnatally. Of those who had severe cerebellar ectopia (grade 3) that underwent postnatal repair, 65.5% (36/55) remained grade 3, while the remaining 34.5% (19/55) improved to grade 2. The degree of postnatal lateral ventriculomegaly in those that underwent prenatal repair (20.3 ± 5.6 mm) was not significantly different from that in those that underwent postnatal repair (21.5 ± 10.2 mm, = .53). Increased Chiari grade was significantly correlated with decreased head size for gestational age on fetal sonography ( = .0054).
In fetuses with open spinal dysraphism and severe Chiari II malformation that do not undergo prenatal repair, most have no change in the severity of cerebellar ectopia/Chiari grade. However, in fetuses that undergo in utero repair, most have resolved cerebellar ectopia postnatally.
随着胎儿脊髓脊膜膨出宫内修复手术的应用日益普遍，了解预期的磁共振成像（MR）表现变得越发重要。我们的目的是检查开放性脊柱裂胎儿的神经影像学表现，重点关注后脑疝和脑室大小，并将其与接受产前和产后修复的组别的产后影像学特征进行比较。
对2004年1月至2015年7月期间有产后影像学资料的开放性脊柱裂胎儿的MRI进行单中心回顾性分析。共纳入102例胎儿。还检查了现有的胎儿超声报告。由2名经过儿科神经放射学专科培训并获得委员会认证的医生对图像进行评估。进行描述性分析以展示影像学表现的分布情况。
102例胎儿中有32例（31.3%）接受了开放性脊柱裂的宫内修复；68.6%（70/102）接受了产后修复。102例胎儿中有94例（92.2%）存在小脑异位。在接受产前修复的胎儿中（26例3级，6例2级），81.3%（26/32）出生后小脑异位得到缓解。在接受产后修复的严重小脑异位（3级）胎儿中，65.5%（36/55）仍为3级，其余34.5%（19/55）改善为2级。接受产前修复的胎儿产后侧脑室扩大程度（20.3±5.6mm）与接受产后修复的胎儿（21.5±10.2mm，P = 0.53）无显著差异。胎儿超声检查显示，Chiari分级增加与孕龄头围减小显著相关（P = 0.0054）。
对于患有开放性脊柱裂和严重Chiari II型畸形且未接受产前修复治疗的胎儿，大多数小脑异位/Chiari分级的严重程度无变化。然而，对于接受宫内修复的胎儿，大多数出生后小脑异位得到缓解。
