From the Departments of Radiology and Biomedical Imaging (E.G., O.A.G.).
Biostatistics Center (C.M.), Milken Institute School of Public Health, The George Washington University, Washington, DC.
AJNR Am J Neuroradiol. 2023 Jul;44(7):861-866. doi: 10.3174/ajnr.A7926. Epub 2023 Jun 29.
Short-term results demonstrate that prenatal repair of a myelomeningocele is associated with a reduction in hydrocephalus and an increased likelihood of the reversal of Chiari II malformations compared with postnatal repair. The purpose of this study was to identify the long-term imaging findings at school age among subjects who underwent pre- versus postnatal repair of a myelomeningocele.
A subset of subjects enrolled in the Management of Myelomeningocele Study who underwent either prenatal ( = 66) or postnatal ( = 63) repair of a lumbosacral myelomeningocele and had follow-up brain MR imaging at school age were included. The prevalence of posterior fossa features of Chiari II malformation and supratentorial abnormalities and the change in these findings from fetal to school-age MR imaging were compared between the 2 groups.
Prenatal repair of a myelomeningocele was associated with higher rates of normal location of fourth ventricle and lower rates of hindbrain herniation, cerebellar herniation, tectal beaking, brainstem distortion, and kinking at school age compared with postnatal repair (all < .01). Supratentorial abnormalities, including corpus callosal abnormalities, gyral abnormalities, heterotopia, and hemorrhage, were not significantly different between the 2 groups (all > .05). The rates of resolution of brainstem kinking, tectal beaking, cerebellar and hindbrain herniation, and normalization of fourth ventricle size from fetal to school age MR imaging were higher among the prenatal compared with postnatal surgery group (all, .02).
Prenatal repair of a myelomeningocele is associated with persistent improvement in posterior fossa imaging findings of Chiari II malformation at school age compared with postnatal repair.
短期研究结果表明，与产后修复相比，产前修复脑脊膜膨出可减少脑积水的发生，并增加 Chiari II 畸形逆转的可能性。本研究的目的是确定在接受产前与产后脑脊膜膨出修复的患者中，在学龄时的长期影像学发现。
本研究纳入了参加 Management of Myelomeningocele 研究的亚组患者，他们接受了腰骶部脑脊膜膨出的产前（n=66）或产后（n=63）修复，并在学龄时进行了脑部磁共振成像（MRI）随访。比较了两组患者 Chiari II 畸形的后颅窝特征和幕上异常的发生率，以及这些发现从胎儿 MRI 到学龄期 MRI 的变化。
与产后修复相比，产前修复脑脊膜膨出与更高的第四脑室正常位置率和更低的后脑疝、小脑疝、顶盖切迹、脑干扭曲和脑桥扭结发生率相关（均 <.01）。幕上异常，包括胼胝体异常、脑回异常、异位和出血，两组之间无显著差异（均 >.05）。与产后手术组相比，产前手术组的脑干扭结、顶盖切迹、小脑和后脑疝的缓解率以及第四脑室大小的正常化率从胎儿 MRI 到学龄期 MRI 更高（均 <.02）。
与产后修复相比，产前修复脑脊膜膨出可在学龄时持续改善 Chiari II 畸形的后颅窝影像学发现。
