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.
BJOG. 2021 Jan;128(2):392-399. doi: 10.1111/1471-0528.16316. Epub 2020 Jun 15.
(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.
Retrospective cohort study.
Texas Children's Hospital, between 2011 and 2018.
Patients who underwent prenatal NTD repair.
Large lesion was defined when the lesion's surface was >75th centile of our cohorts' lesions.
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.
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).
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.
Evaluation of the size of fetal NTD can predict adverse neurological outcomes after prenatal NTD repair.
(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。
回顾性队列研究。
德克萨斯州儿童医院，2011 年至 2018 年。
接受产前 NTD 修复的患者。
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。
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。
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）。
产前修复大 NTD 患者，术后 6 周 HBH 逆转的比例较低，缝合不良的风险较高，需要产后修复。
胎儿 NTD 大小的评估可以预测产前 NTD 修复后的不良神经结局。
