Prenatal and postnatal MRI findings in open spinal dysraphism following intrauterine repair via open versus fetoscopic surgical techniques

Prenat Diagn. 2020 Jan;40(1):49-57. doi: 10.1002/pd.5540. Epub 2019 Aug 13.

Abstract

Purpose: The purpose of the study is to examine MRI findings of the brain and spine on prenatal and postnatal MRI following intrauterine repair of open spinal dysraphism (OSD) by open hysterotomy and fetoscopic approaches.

Materials and methods: This study is a single-center HIPAA-compliant and IRB-approved retrospective analysis of fetal MRIs with open spinal dysraphism from January 2011 through December 2018 that underwent subsequent prenatal repair of OSD.

Results: Sixty-two patients met inclusion criteria: 47 underwent open repair, and 15 underwent fetoscopic repair, with an average gestational age of 22.6 ± 1.4 weeks at initial MRI. On postnatal MRI, spinal cord syrinx was seen in 34% (16/47) of patients undergoing open versus 33.3% (5/15) undergoing fetoscopic repair (P = 0.96). Postnatally, there was no significant difference in hindbrain herniation between the open versus fetoscopic repair groups (P = 0.28). Lateral ventricular size was significantly larger in the open (20.9 ± 6.7 mm) versus the fetoscopic repair (16.1 ± 4.9 mm) group (P = 0.01).

Conclusion: Though lateral ventricular size in the open repair group was larger than the fetoscopic repair group, this can likely be explained by initial selection criteria used for fetoscopic repair. Other postoperative imaging parameters on postnatal MRI were not significantly different between the two groups.

MeSH terms

  • Brain / diagnostic imaging
  • Encephalocele / diagnostic imaging*
  • Female
  • Fetal Diseases / diagnostic imaging
  • Fetal Diseases / surgery
  • Fetal Therapies / methods*
  • Fetoscopy / methods*
  • Gestational Age
  • Humans
  • Hysterotomy / methods
  • Infant, Newborn
  • Infant, Newborn, Diseases / diagnostic imaging
  • Infant, Newborn, Diseases / surgery
  • Intracranial Hemorrhages / diagnostic imaging*
  • Lateral Ventricles / diagnostic imaging
  • Magnetic Resonance Imaging
  • Male
  • Meningomyelocele / diagnostic imaging*
  • Meningomyelocele / surgery
  • Patient Selection
  • Pregnancy
  • Prenatal Diagnosis
  • Retrospective Studies
  • Spina Bifida Cystica / diagnostic imaging*
  • Spina Bifida Cystica / surgery
  • Spinal Cord / diagnostic imaging
  • Syringomyelia / diagnostic imaging*
  • Ultrasonography, Prenatal