Prenatal predictors of motor function in children with open spina bifida: a retrospective cohort study

Abstract

Objective To identify predictors for intact motor function (MF) at birth and at 12 months of life in babies with prenatally versus postnatally repaired open spina bifida (OSB). Design Retrospective cohort study.

Impact of the cystic neural tube defects on fetal motor function in prenatal myelomeningocele repairs: A retrospective cohort study

“…They observed similar results in a post‐hoc analysis of the MOMS trial cohort 18 . Our series concurs with their findings using a single institution series of prenatally repaired subjects 11 …”

“…18 concurs with their findings using a single institution series of prenatally repaired subjects. 11 Wilson et al investigated the relationship between the presence of an MMC sac and motor function at birth and at 1 year of age in 54 fetuses who underwent a repair by hysterotomy. 10 Although there was no significant difference there seemed to be a trend for increased motor impairment at birth and 1 year of age in cases with a sac.…”

“…9 A similar, albeit not statistically significant trend was also previously reported by Wilson et al 10 Along the same lines, a recent study showed that flat ONTD lesion were 11.2 times more likely to have intact motor function (MF) at birth following prenatal repair. 11 This could be related to the additional neurologic injury, a third hit, which may result from cerebrospinal fluid hydrostatic forces within the MMC sac with secondary stretching of the neural placode and spinal nerves, which would represent an additional acquired mechanism of injury in cases of open spinal dysraphism. 9 The objective of our study was to determine the relationship between the type of lesion (cystic or flat) and the fetal MF in prenatal MMC repair candidates, using a simple and reproducible ultrasound technique described by Carreras & Maroto.…”

Fetal open spinal dysraphism repair through a mini‐hysterotomy: Influence of gestational age at surgery on children's ability to walk

“…6,7 Since, other technical approaches for fetal OSD correction have been proposed, mainly to try and reduce maternal and fetal morbidities and possibly to improve neuroprotection. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] Some research groups have tested modifications to the classical hysterotomy procedure used in the MoMs trial, with the main purposes of minimizing uterine injury and allowing for an earlier correction of the OSD. 17,19,21,23 Likewise, the fetoscopic approach, which follows the natural trend of any kind of fetal surgery, has been tested in order to reduce maternal surgical trauma.…”

“…17,19,21,23 Likewise, the fetoscopic approach, which follows the natural trend of any kind of fetal surgery, has been tested in order to reduce maternal surgical trauma. [11][12][13][14][15][16]18,20,22,24 In a previous study, our group demonstrated that infants who undergo an in utero correction of an OSD through a minihysterotomy (2.5-3.5 cm) at an earlier gestational age (GA) (from 19 to 27 weeks of gestation) are less prone to need a postnatal ventriculoperitoneal shunt (VPS). 23 The mini-hysterotomy allows for a safe yet early correction of the fetal OSD, which may be more difficult to achieve by using the classical hysterotomy or any variation of the fetoscopic approach.…”