Pastuszka Agnieszka, Koszutski Tomasz, Horzelska Ewa, Marciniak Sylwia, Zamłyński Mateusz, Olejek Anita
Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia, 40-055 Katowice, Poland.
Department of Pediatric Surgery and Urology, Faculty of Medical Sciences, Medical University of Silesia, 40-055 Katowice, Poland.
Diagnostics (Basel). 2023 Jan 17;13(3):343. doi: 10.3390/diagnostics13030343.
Spina bifida aperta (SBA), with (myelomeningocele) or without (myeloschisis) a hernia sack, is the most common congenital defect of the central nervous system. Prenatal surgical closure of SBA lowers the risk for developing shunt-dependent hydrocephalus, which offers a chance at improved motor, urinary, and gastrointestinal function. A total of 96 patients who had undergone open surgery prenatal repair for SBA were analyzed. The patients were divided into two groups: Group I-12 patients (12.5%)-without a hernia sack (myeloschisis) and Group II-84 patients (87.5%)-with a hernia sack (myelomeningocele). In this study, we demonstrated that prenatal SBA repair was statistically significantly less often associated with the need for ventriculoperitoneal shunting ( > 0.00001). The shunting was statistically significantly more often required in patients from Group I ( > 0.004). The absence of a hernia sack increases the risk for developing shunt-dependent hydrocephalus in patients after prenatal SBA repair. However, as prenatal SBA repair is associated with better motor, urinary, and gastrointestinal function, increased risk of developing shunt-dependent hydrocephalus in fetuses without a hernia sack should not be treated as a contraindication to prenatal intervention.
开放性脊柱裂（SBA），伴有（脊髓脊膜膨出）或不伴有（脊髓裂）疝囊，是最常见的中枢神经系统先天性缺陷。产前手术闭合SBA可降低发生依赖分流的脑积水的风险，这为改善运动、泌尿和胃肠功能提供了机会。对96例接受开放性产前手术修复SBA的患者进行了分析。患者分为两组：第一组-12例患者（12.5%）-无疝囊（脊髓裂），第二组-84例患者（87.5%）-有疝囊（脊髓脊膜膨出）。在本研究中，我们证明产前SBA修复与脑室腹腔分流术需求的相关性在统计学上显著降低（>0.00001）。第一组患者在统计学上更常需要进行分流术（>0.004）。无疝囊会增加产前SBA修复术后患者发生依赖分流的脑积水的风险。然而，由于产前SBA修复与更好的运动、泌尿和胃肠功能相关，无疝囊胎儿发生依赖分流的脑积水风险增加不应被视为产前干预的禁忌证。
