da Costa Marcos Devanir Silva, Nicacio Jardel Mendonça, Dastoli Patricia Alessandra, Suriano Italo Capraro, Sarmento Stéphanno Gomes Pereira, Barbosa Mauricio Mendes, Moron Antonio Fernandes, Cavalheiro Sergio
Department of Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil.
Department of Fetal Neurosurgery, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil.
Childs Nerv Syst. 2020 Nov;36(11):2757-2763. doi: 10.1007/s00381-020-04587-6. Epub 2020 Apr 1.
The aim of this study was to analyze the skull base anatomy of patients who underwent intrauterine or postnatal myelomeningocele repair and to determine its relationship with hydrocephalus.
This was a retrospective cross-sectional study that analyzed three groups: the postnatal group, 57 patients who underwent myelomeningocele repair up to 48 h after birth; the fetal group, 70 patients who underwent myelomeningocele repair between 19 and 27 weeks of gestation; and a control group (65). We compared the rate of hydrocephalus treatment, the clivus-supraocciput angle (CSA), and the Welcher angle.
The mean CSA in the fetal group was 87.6°, and the postnatal group was significantly different at 78.3° (p < 0.0001). The control group (89.1°) was significantly different from the postnatal group but not from the fetal group. The mean Welcher angle was not significantly different between the groups. There was an 8.5% rate of surgical treatment for hydrocephalus in the fetal group, compared with 73.6% in the postnatal group.
The CSA in the fetal group was larger than that in the postnatal group, which may explain the decrease in the prevalence of hydrocephalus in the fetal group.
本研究旨在分析接受宫内或出生后脊髓脊膜膨出修补术患者的颅底解剖结构，并确定其与脑积水的关系。
这是一项回顾性横断面研究，分析了三组：出生后组，57例出生后48小时内接受脊髓脊膜膨出修补术的患者；胎儿组，70例在妊娠19至27周接受脊髓脊膜膨出修补术的患者；以及一个对照组（65例）。我们比较了脑积水治疗率、斜坡-枕骨上缘角（CSA）和韦尔彻角。
胎儿组的平均CSA为87.6°，出生后组为78.3°，差异有统计学意义（p<0.0001）。对照组（89.1°）与出生后组差异有统计学意义，但与胎儿组差异无统计学意义。各组之间的平均韦尔彻角差异无统计学意义。胎儿组脑积水手术治疗率为8.5%，出生后组为73.6%。
胎儿组的CSA大于出生后组，这可能解释了胎儿组脑积水患病率的降低。
