Vol 89, No 11 (2018)
Review paper
Published online: 2018-11-30
Contemporary management of prenatally diagnosed spina bifida aperta — an update
Abstract
Spina bifida aperta is a relatively common congenital defect that occurs in the general population. Once the disorder has
been diagnosed, a discussion, that can be emotionally-charged, ensues about whether to treat it prenatally or to only offer surgery postnatally. Given that there are good arguments for and against both options, it is of paramount importance to gain a good understanding of the major advantages and disadvantages of the various surgical approaches. The aim of our paper is to summarize current knowledge about spina bifida and the potential benefits of prenatal surgery.
References
- Moldenhauer JS, Adzick NS. Fetal surgery for myelomeningocele: After the Management of Myelomeningocele Study (MOMS). Semin Fetal Neonatal Med. 2017; 22(6): 360–366.
- Adzick NS. Fetal surgery for spina bifida: past, present, future. Semin Pediatr Surg. 2013; 22(1): 10–17.
- Mohd-Zin SW, Marwan AI, Abou Chaar MK, et al. Spina Bifida: Pathogenesis, Mechanisms, and Genes in Mice and Humans. Scientifica (Cairo). 2017; 2017: 5364827.
- Mitchell LE, Adzick NS, Melchionne J, et al. Spina bifida. Lancet. 2004; 364(9448): 1885–1895.
- Rintoul NE, Sutton LN, Hubbard AM, et al. A New Look at Myelomeningoceles: Functional Level, Vertebral Level, Shunting, and the Implications for Fetal Intervention. PEDIATRICS. 2002; 109(3): 409–413.
- Cochrane DD, Wilson RD, Steinbok P, et al. Prenatal spinal evaluation and functional outcome of patients born with myelomeningocele: information for improved prenatal counselling and outcome prediction. Fetal Diagn Ther. 1996; 11(3): 159–168.
- Williams H. A unifying hypothesis for hydrocephalus, Chiari malformation, syringomyelia, anencephaly and spina bifida. Cerebrospinal Fluid Res. 2008; 5: 7.
- Bowman RM, McLone DG, Grant JA, et al. Spina bifida outcome: a 25-year prospective. Pediatr Neurosurg. 2001; 34(3): 114–120.
- Borgstedt-Bakke JH, Fenger-Grøn M, Rasmussen MM. Correlation of mortality with lesion level in patients with myelomeningocele: a population-based study. J Neurosurg Pediatr. 2017; 19(2): 227–231.
- Van den Hof MC, Nicolaides KH, Campbell J, et al. Ultrasound screening for spina bifida: cranial and cerebellar signs. Lancet. 1986; 2(8498): 72–74.
- Chaoui R, Nicolaides KH. Detecting open spina bifida at the 11-13-week scan by assessing intracranial translucency and the posterior brain region: mid-sagittal or axial plane? Ultrasound Obstet Gynecol. 2011; 38(6): 609–612.
- Chaoui R, Nicolaides KH. From nuchal translucency to intracranial translucency: towards the early detection of spina bifida. Ultrasound Obstet Gynecol. 2010; 35(2): 133–138.
- Bahlmann F, Reinhard I, Schramm T, et al. Cranial and cerebral signs in the diagnosis of spina bifida between 18 and 22 weeks of gestation: a German multicentre study. Prenat Diagn. 2015; 35(3): 228–235.
- Meuli M, Meuli-Simmen C, Yingling CD, et al. In utero repair of experimental myelomeningocele saves neurological function at birth. J Pediatr Surg. 1996; 31(3): 397–402.
- Paek BW, Farmer DL, Wilkinson CC, et al. Hindbrain herniation develops in surgically created myelomeningocele but is absent after repair in fetal lambs. Am J Obstet Gynecol. 2000; 183(5): 1119–1123.
- Committee on Obstetric Practice, Society for Maternal–Fetal Medicine. Committee Opinion No. 720 Summary: Maternal-Fetal Surgery for Myelomeningocele. Obstet Gynecol. 2017; 130(3): 164–167.
- Adzick NS, Thom EA, Spong CY, et al. MOMS Investigators. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med. 2011; 364(11): 993–1004.
- Blumenfeld YJ, Belfort MA. Updates in fetal spina bifida repair. Curr Opin Obstet Gynecol. 2018; 30(2): 123–129.
- Wilson RD, Lemerand K, Johnson MP, et al. Reproductive outcomes after pregnancy complicated by maternal-fetal surgery. Am J Obstet Gynecol. 2004; 191(4): 1430–1436.
- Bruner JP, Tulipan NE, Richards WO. Endoscopic coverage of fetal open myelomeningocele in utero. Am J Obstet Gynecol. 1997; 176(1 Pt 1): 256–257.
- Kohl T, Hering R, Heep A, et al. Percutaneous fetoscopic patch coverage of spina bifida aperta in the human--early clinical experience and potential. Fetal Diagn Ther. 2006; 21(2): 185–193.
- Verbeek RJ, Heep A, Maurits NM, et al. Fetal endoscopic myelomeningocele closure preserves segmental neurological function. Dev Med Child Neurol. 2012; 54(1): 15–22.
- Shurtleff D. Fetal endoscopic myelomeningocele repair. Dev Med Child Neurol. 2012; 54(1): 4–5.
- Arens C, Koch C, Veit M, et al. Anesthetic Management for Percutaneous Minimally Invasive Fetoscopic Surgery of Spina Bifida Aperta: A Retrospective, Descriptive Report of Clinical Experience. Anesth Analg. 2017; 125(1): 219–222.
- Kohl T. Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta. Part I: surgical technique and perioperative outcome. Ultrasound Obstet Gynecol. 2014; 44(5): 515–524.
- Degenhardt J, Schürg R, Winarno A, et al. Percutaneous minimal-access fetoscopic surgery for spina bifida aperta. Part II: maternal management and outcome. Ultrasound Obstet Gynecol. 2014; 44(5): 525–531.
- Pedreira DAL, Zanon N, Nishikuni K, et al. Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial. Am J Obstet Gynecol. 2016; 214(1): 111.e1–111.e11.
- Belfort MA, Whitehead WE, Bednov A, et al. Fetoscopic Repair of Meningo-myelocele. Obstet Gynecol. 2015; 126(4): 881–884.
- Belfort MA, Whitehead WE, Shamshirsaz AA, et al. Fetoscopic Open Neural Tube Defect Repair: Development and Refinement of a Two-Port, Carbon Dioxide Insufflation Technique. Obstet Gynecol. 2017; 129(4): 734–743.
- Johnson MP, Bennett KA, Rand L, et al. The Management of Myelomeningocele Study: obstetrical outcomes and risk factors for obstetrical complications following prenatal surgery. Am J Obstet Gynecol. 2016; 215(6): 778.e1–778.e9.
- Herrera SR, Leme RJ, Valente PR, et al. Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep. Einstein (Sao Paulo). 2012; 10(4): 455–461.
