Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK.
Department of Paediatric Urology, St George's University Hospitals NHS Foundation Trust, London, UK.
Ultrasound Obstet Gynecol. 2019 Mar;53(3):309-313. doi: 10.1002/uog.20215. Epub 2019 Feb 6.
Parents faced with the choice between postnatal management and prenatal surgery for spina bifida need to have up-to-date information on the expected outcomes. The aim of this study was to report the long-term physical and neurological outcomes of infants with prenatally diagnosed isolated spina bifida that underwent postnatal surgical repair and were managed by a multidisciplinary team from a large tertiary center.
This was a retrospective cohort study of all cases of fetal spina bifida managed in a tertiary unit between October 1999 and January 2018. All cases of fetal spina bifida from the local health region were routinely referred to the tertiary unit for further perinatal management. Details on surgical procedures and neonatal neurological outcomes were obtained from institutional case records. Ambulatory status, bladder and bowel continence and neurodevelopment were assessed at a minimum of 3 years.
During the study period, 241 pregnancies with isolated spina bifida were seen in the unit. Of these, 84 (34.9%) women opted to continue with the pregnancy after multidisciplinary counseling by clinicians. Sixty-seven infants underwent postnatal repair of spina bifida aperta and were included in the analysis. After birth, hindbrain herniation was observed in 91.5% of infants with only seven requiring surgical decompression. Ventriculoperitoneal shunt placement was needed in 64.2% of infants, while normal cognitive development or mild impairment was demonstrated in 85.4% of cases with data for this outcome available, at a mean age of 8 years. Cumulatively, 40% of infants were walking independently or using minor support, and normal or mild impairment of bladder and bowel function was reported in 45.5% and 44.4% of infants, respectively.
Neurodevelopmental and neurological outcomes between prenatal and postnatal repair are similar. As with fetal surgery, conventional postnatal surgery is associated with the reversal of hindbrain herniation. Similarly, postnatal ventriculoperitoneal shunt placement appears to be required mainly in fetuses without evidence of significant fetal ventriculomegaly. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
面对脊髓脊膜膨出的产后管理和产前手术选择，父母需要掌握最新的预期结果信息。本研究旨在报告在大型三级中心的多学科团队管理下，接受产后手术修复的产前诊断为单纯性脊髓脊膜膨出的婴儿的长期身体和神经结局。
这是一项对 1999 年 10 月至 2018 年 1 月在三级医院接受治疗的所有胎儿脊髓脊膜膨出病例进行的回顾性队列研究。当地卫生区域的所有胎儿脊髓脊膜膨出病例均常规转介至三级医院进行进一步围产期管理。从机构病历中获得了手术程序和新生儿神经结局的详细信息。至少在 3 年后评估了活动能力、膀胱和肠道控便能力以及神经发育情况。
在研究期间，该单位共收治 241 例单纯性脊髓脊膜膨出孕妇。其中，84 例（34.9%）女性在临床医生的多学科咨询后选择继续妊娠。67 例婴儿接受了开放性脊髓脊膜膨出的产后修复，并纳入分析。出生后，91.5%的婴儿出现后脑疝，仅 7 例需要手术减压。64.2%的婴儿需要放置脑室-腹腔分流管，85.4%有认知发展数据的婴儿结果正常或轻度受损，平均年龄为 8 岁。累积而言，40%的婴儿可独立行走或使用辅助工具，45.5%和 44.4%的婴儿报告膀胱和肠道功能正常或轻度受损。
产前和产后修复的神经发育和神经结局相似。与胎儿手术一样，常规的产后手术与后脑疝的逆转有关。同样，产后脑室-腹腔分流管的放置似乎主要需要在没有明显胎儿脑室扩大证据的胎儿中进行。版权所有 © 2019 ISUOG。由 John Wiley & Sons Ltd 出版。
