产前神经管缺陷修复中病变大小对影像学、神经外科学和运动学结果的影响：一项回顾性队列研究。

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

机构信息

Department of Obstetrics and Gynecology, Texas Children's Hospital & Baylor College of Medicine, Houston, Texas, USA.

Department of Neurosurgery, Texas Children's Hospital & Baylor College of Medicine, Houston, Texas, USA.

出版信息

BJOG. 2021 Jan;128(2):392-399. doi: 10.1111/1471-0528.16316. Epub 2020 Jun 15.

DOI:10.1111/1471-0528.16316

PMID:32406575

Abstract

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 < 0.01). At birth, larger lesions increased the risk for repair dehiscence by 6.1 times (95% CI 1.6-22.5, P < 0.01) and the risk of dehiscence or leakage of cerebrospinal fluid at birth by 5.5 times (95% CI 1.6-18.9, P < 0.01).

CONCLUSION

Prenatal repair of patients with large NTD presents a lower proportion of HBH reversal 6 weeks after the surgery, a higher risk of dehiscence and a higher need for postnatal repair.

TWEETABLE ABSTRACT

Evaluation of the size of fetal NTD can predict adverse neurological outcomes after prenatal NTD repair.

摘要

目的

(1)比较大的和非大的神经管缺陷（NTD）之间的脑部发现；(2)评估大病灶对手术参数的影响；(3)研究病变大小与术后 6 周的脑发现和神经短期结果之间的任何关联。

设计

回顾性队列研究。

地点

德克萨斯州儿童医院，2011 年至 2018 年。

人群

接受产前 NTD 修复的患者。

方法

当病变的表面大于我们队列病变的第 75 百分位数时，定义为大病变。

主要观察指标

转诊时间：脑积水量和病变的解剖水平；手术时间：手术时间和放松切口的需要。术后 6 周：后脑疝（HBH）和脑积水量。分娩后：缝合不良、脑积水治疗和运动功能的需要。

结果

共纳入 99 例患者，其中 25 例为大病灶。大病灶和脑积水量在大病灶和非大病灶患者之间无差异。大病灶患者需要放松切口的可能性增加了 5.4 倍（95%可信区间 1.3-23.2，P=0.02）。术后 6 周，大病灶患者出现术后 HBH 逆转的可能性降低了 10 倍（比值比 0.1，95%可信区间 0.1-0.4，P<0.01）。出生时，较大的病灶使修补术缝合不良的风险增加了 6.1 倍（95%可信区间 1.6-22.5，P<0.01），出生时缝合不良或脑脊液漏的风险增加了 5.5 倍（95%可信区间 1.6-18.9，P<0.01）。