Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.
Maternal Fetal Medicine Division, Department of Obstetrics and Gynaecology, College of Medicine, King Saud bin Abdulaziz University for Health Sciences - Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia.
Ultrasound Obstet Gynecol. 2022 Jun;59(6):799-803. doi: 10.1002/uog.24767.
Open spina bifida is a common cause of hydrocephalus in the postnatal period. In-utero closure of the fetal spinal defect decreases the need for postnatal cerebrospinal fluid (CSF) diversion surgery. Good prenatal predictors of the need for postnatal CSF diversion surgery are currently lacking. In this study, we aimed to assess the association of fetal ventriculomegaly and its progression over the course of pregnancy with the rate of postnatal hydrocephalus requiring intervention.
In this retrospective study, fetuses with a prenatal diagnosis of open spina bifida were assessed longitudinally. Ventricular diameter, as well as other potential predictors of the need for postnatal CSF diversion surgery, were compared between fetuses undergoing prenatal closure and those undergoing postnatal repair.
The diameter of the lateral ventricle increased significantly throughout gestation in both groups, but there was no difference in maximum ventricular diameter at first or last assessment between fetuses undergoing prenatal closure and those undergoing postnatal repair. There was no significant difference in the rate of progression of ventriculomegaly between the two groups, with a mean progression rate of 0.83 ± 0.5 mm/week in the prenatal-repair group and 0.6 ± 0.6 mm/week in the postnatal-repair group (P = 0.098). Fetal repair of open spina bifida was associated with a lower rate of postnatal CSF diversion surgery (P < 0.001). In all subjects, regardless of whether they had prenatal or postnatal surgery, the severity of ventriculomegaly at first and last assessments was associated independently with the need for postnatal CSF diversion surgery (P = 0.005 and P = 0.001, respectively), with a greater need for surgery in fetuses with larger ventricular size, even after controlling for gestational age at assessment.
In fetuses with open spina bifida, fetal ventricular size increases regardless of whether spina bifida closure is performed prenatally or postnatally, but the need for CSF diversion surgery is significantly lower in those undergoing prenatal repair. Ventriculomegaly is associated independently with the need for postnatal CSF diversion in fetuses with open spina bifida, irrespective of timing of closure. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
开放性脊柱裂是新生儿期脑积水的常见原因。胎儿脊柱缺陷的宫内闭合可减少新生儿期脑脊液（CSF）分流术的需求。目前缺乏预测新生儿 CSF 分流术需求的良好产前指标。本研究旨在评估胎儿脑室扩大及其在妊娠过程中的进展与需要进行新生儿脑积水干预的比率之间的关系。
在这项回顾性研究中，对产前诊断为开放性脊柱裂的胎儿进行了纵向评估。比较了行产前闭合术和行产后修复术的胎儿之间脑室直径以及其他潜在的 CSF 分流术需求预测指标。
两组胎儿的侧脑室直径在整个孕期均显著增加，但行产前闭合术和行产后修复术的胎儿在首次和末次评估时的最大脑室直径无差异。两组脑室扩大的进展率无显著差异，产前修复组的平均进展率为 0.83±0.5mm/周，产后修复组为 0.6±0.6mm/周（P=0.098）。开放性脊柱裂的胎儿修复与较低的新生儿 CSF 分流术率相关（P<0.001）。在所有受试者中，无论是否进行了产前或产后手术，首次和末次评估时脑室扩大的严重程度均与新生儿 CSF 分流术的需求独立相关（P=0.005 和 P=0.001），即使在控制评估时的胎龄后，脑室较大的胎儿更需要手术。
在开放性脊柱裂胎儿中，无论是否进行产前脊柱裂闭合术，胎儿脑室大小均会增加，但行产前修复的患儿 CSF 分流术的需求明显较低。脑室扩大与开放性脊柱裂胎儿需要进行新生儿 CSF 分流术独立相关，与闭合术的时机无关。©2021 年国际妇产科超声学会。
