Kik Charlotte C, Kunpalin Yada, Kulkarni Abhaya V, Varghese Abby, Abbasi Nimrah, Ryan Greg, Dekoninck Philip L J, Church Paige T, Malhotra Armaan, Raghuram Kamini, Kelly Edmond, Van Mieghem Tim
Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada.
Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Prenat Diagn. 2024 Dec;44(13):1635-1640. doi: 10.1002/pd.6689. Epub 2024 Oct 19.
To assess contemporary outcomes of fetuses who underwent open fetal spina bifida surgery in Canada.
Our clinical program prospectively collected outcomes of all consecutive fetuses who underwent open fetal spina bifida closure at the Ontario Fetal Center in Toronto and who were at least 1 year of age at the time of postnatal follow-up. We gathered information on the need for hydrocephalus treatment, motor function, bladder function, as well as neurodevelopment (Ages and Stages Questionnaire and Bayley's scales of infant development). Developmental outcomes were categorized as "Typical Development," "Possible Delay," or "Significantly Delayed."
Between 2017 and 2022, 41 fetuses underwent open fetal spina bifida closure. Twenty-four patients (58.5%) responded to the questionnaire at a median age of 46.5 months. Eight children (33.3%) required CSF diversion procedures. Bladder management included clean intermittent catheterization (43.5%), spontaneous voiding (34.8%), or both (21.7%), with 43.5% needing medication for overactive bladder. All patients could sit independently, with 50% walking outside and 50% crawling indoors. Among those walking outdoors (50%), 25% did so without orthotics or aid, 58.3% with orthotics, and 16.7% required additional walking aids. Most children demonstrated typical communication and problem-solving skills (79.2%), while gross motor development was significantly delayed in 91.7% of cases. Fine motor skills varied, with 56.5% showing typical development and 34.8% possibly experiencing delays.
This study showed a mixed developmental profile among patients who underwent open fetal spina bifida repair, consistent with the MOMs trial findings.
评估在加拿大接受开放性胎儿脊柱裂手术的胎儿的当代治疗效果。
我们的临床项目前瞻性地收集了所有在多伦多安大略胎儿中心接受开放性胎儿脊柱裂闭合手术且在产后随访时至少1岁的连续胎儿的治疗效果。我们收集了有关脑积水治疗需求、运动功能、膀胱功能以及神经发育（年龄与阶段问卷和贝利婴儿发育量表）的信息。发育结果分为“典型发育”“可能延迟”或“显著延迟”。
2017年至2022年期间，41例胎儿接受了开放性胎儿脊柱裂闭合手术。24名患者（58.5%）在中位年龄46.5个月时回复了问卷。8名儿童（33.3%）需要脑脊液分流手术。膀胱管理包括清洁间歇性导尿（43.5%）、自主排尿（34.8%）或两者皆有（21.7%），43.5%的患者需要药物治疗膀胱过度活动症。所有患者都能独立坐立，50%的患者能在户外行走，50%的患者能在室内爬行。在户外行走的患者中（50%），25%无需矫形器或辅助设备就能行走，58.3%需要矫形器，16.7%需要额外的行走辅助设备。大多数儿童表现出典型的沟通和解决问题的能力（79.2%），而91.7%的病例中粗大运动发育显著延迟。精细运动技能各不相同，56.5%表现为典型发育，34.8%可能存在延迟。
本研究显示，接受开放性胎儿脊柱裂修复手术的患者发育情况参差不齐，这与MOMs试验的结果一致。
