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Bruzek AK, Koller GM, Karuparti S, Varagur K, Dunbar A, Flanders TM, Mingo M, Sudanagunta K, Bligard KH, Odibo A, Vrecenak J, Mian A, Strahle JM. MRI analysis of neurodevelopmental anatomy in myelomeningocele: prenatal vs postnatal repair. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:362-373. [PMID: 38237046 DOI: 10.1002/uog.27586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/28/2023] [Accepted: 12/06/2023] [Indexed: 08/02/2024]
Abstract
OBJECTIVE Compared with postnatal repair, prenatal myelomeningocele (MMC) repair is associated with improved motor function and decreased need for cerebrospinal fluid (CSF) diversion. It is unknown how prenatal surgery alters neuroanatomical structures identifiable on magnetic resonance imaging (MRI). The purpose of this study was to use MRI to compare neurodevelopmental anatomy in patients undergoing fetal MMC repair compared with those undergoing postnatal repair. METHODS This was a retrospective review of neonates who underwent prenatal or postnatal MMC repair at our institution between 2016 and 2021. Imaging data, including prenatal ultrasound and pre- and postnatal MRI examinations, if available, were retrieved. We analyzed anatomical findings characteristically seen on MRI of the neuroaxis in patients with MMC and compared imaging findings between patients with prenatal vs postnatal MMC repair. RESULTS The study population included 61 patients who underwent surgical repair for MMC during the 6-year study period, of whom 25 underwent prenatal repair and 36 postnatal repair. CSF diversion was required in 24% of the prenatally repaired cohort vs 67% of the postnatally repaired cohort (P = 0.001). On postnatal MRI, a syrinx was present in 13% of the prenatally repaired cohort vs 42% in the postnatally repaired cohort (P = 0.02). Postnatal corpus callosal (CC) morphology was abnormal in 54% of the prenatally repaired cohort vs 53% of the postnatally repaired cohort (P = 0.92), while falx morphology was normal in 92% of the prenatally repaired cohort vs 34% of the postnatally repaired cohort (P < 0.001). On postnatal MRI, patients in the prenatally repaired cohort had a shorter tentorium-to-foramen-magnum distance compared with those in the postnatally repaired cohort (mean, 18.43 mm vs 22.42 mm; P = 0.01), a larger foramen magnum diameter (mean, 22.87 mm vs 18.94 mm; P < 0.001) and a smaller degree of hindbrain herniation (mean, 1.53 mm vs 8.72 mm; P < 0.001). The cerebral aqueduct was patent in 79% of the prenatally repaired cohort vs 100% of the postnatally repaired cohort on postnatal MRI (P = 0.008). Between the two cohorts, at postnatal MRI there was no significant difference in the presence of gray-matter heterotopia, presence of the septum pellucidum or size of the massa intermedia. CONCLUSIONS We report variations in developmental neuroanatomy in patients with MMC, including rates of CC dysgenesis, gray-matter heterotopia and additional cranial and spinal MRI findings. Compared to postnatal surgery, prenatal surgery is associated with changes to infratentorial anatomy, with minimal effect on supratentorial brain development. This information will be useful in counseling parents affected by fetal MMC and in understanding how prenatal repair of MMC affects brain development. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A K Bruzek
- Department of Neurosurgery, Washington University, St Louis, MO, USA
| | - G M Koller
- Department of Neurosurgery, Washington University, St Louis, MO, USA
| | - S Karuparti
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - K Varagur
- Department of Neurosurgery, Washington University, St Louis, MO, USA
| | - A Dunbar
- Department of Neurosurgery, Washington University, St Louis, MO, USA
| | - T M Flanders
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Mingo
- Department of Radiology, Washington University, St Louis, MO, USA
| | - K Sudanagunta
- Department of Radiology, Washington University, St Louis, MO, USA
| | - K H Bligard
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Ultrasound, Washington University, St Louis, MO, USA
| | - A Odibo
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Ultrasound, Washington University, St Louis, MO, USA
| | - J Vrecenak
- Department of Surgery, Washington University, St Louis, MO, USA
| | - A Mian
- Department of Radiology, Washington University, St Louis, MO, USA
| | - J M Strahle
- Department of Neurosurgery, Washington University, St Louis, MO, USA
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Guilbaud L, Carreras E, Garel C, Maiz N, Dhombres F, Deprest J, Jouannic JM. Proposal for standardized prenatal assessment of fetal open dysraphisms by the European reference network for Intellectual disability, TeleHealth, Autism and Congenital Anomalies (ITHACA) and eUROGEN. Prenat Diagn 2024; 44:1073-1087. [PMID: 38898590 DOI: 10.1002/pd.6618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
Open dysraphisms, that is, myelomeningocele and myeloschisis, are rare diseases associated with a risk of severe disability, including lower limb motor and sensory deficiency, sphincter deficiency, and potential intellectual deficiency. Open dysraphism is diagnosed in Europe in 93.5% of cases. In case of suspicion of fetal open dysraphism, a detailed fetal morphologic assessment is required to confirm the diagnosis and exclude associated structural anomalies, as well as genetic assessment. In case of isolated fetal open dysraphism, assessment of prognosis is based on fetal imaging including the level of the lesion, the presence or not of a sac, the presence and nature of intra cranial anomalies, and the anatomical and functional evaluation of the lower extremities. Based on these biomarkers, a personalized prognosis as well as comprehensive information about prenatal management alternatives will allow parents to decide on further management options. Standardization of prenatal assessment is essential to compare outcomes with benchmark data and make assessment of surgical innovation possible. Herein, we propose a protocol for the standardized ultrasound assessment of fetuses with isolated open dysraphism.
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Affiliation(s)
- Lucie Guilbaud
- Fetal Medicine Department, Armand Trousseau University Hospital, Spin@ Reference Center, Sorbonne University, Paris, France
| | - Elena Carreras
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Catherine Garel
- Pediatric Radiology Department, Armand Trousseau University Hospital, Sorbonne University, Paris, France
| | - Nerea Maiz
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ferdinand Dhombres
- Fetal Medicine Department, Armand Trousseau University Hospital, Spin@ Reference Center, Sorbonne University, Paris, France
| | - Jan Deprest
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Institute of Women's Health, University College London, London, UK
| | - Jean-Marie Jouannic
- Fetal Medicine Department, Armand Trousseau University Hospital, Spin@ Reference Center, Sorbonne University, Paris, France
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Koneru S, Bhavsar S, Pugazenthi S, Koller GM, Karuparti S, Kann MR, Strahle JM. A qualitative analysis of patient and caregiver experiences with myelomeningocele through online discussion boards. Childs Nerv Syst 2024; 40:1783-1790. [PMID: 38578480 DOI: 10.1007/s00381-024-06331-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/21/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Patients and caregivers impacted by myelomeningocele (MMC) use online discussion board forums to create community and share information and concerns about this complex medical condition. We aim to identify the primary concerns expressed on these forums with the goal of understanding gaps in care that may merit investment of resources to improve care received by this population. METHODS Anonymous posts from online MMC discussion boards were compiled using internet search engines. Posts were then analyzed using an adaptation of the Grounded Theory Method, a three-step system involving open, axial, and selective coding of the data by two independent researchers to identify common themes. RESULTS Analysis of 400 posts written primarily by parents (n = 342, 85.5%) and patients (n = 45, 11.25%) yielded three overarching themes: questions surrounding quality of life, a lack of support for mothers of children with MMC, and confusion with a complex healthcare system. Many posts revealed concerns about management and well-being with MMC, including posts discussing symptoms and related conditions (n = 299, 75.75%), treatments (n = 259, 65.75%), and emotional aspects of MMC (n = 146, 36.5%). Additionally, families, especially mothers, felt a lack of support in their roles as caregivers. Finally, in 118 posts (29.5%), patients and families expressed frustration with navigating a complex healthcare system and finding specialists whose opinions they trusted. CONCLUSIONS MMC is a complex medical condition that impacts patients and families in unique ways. Analysis of online discussion board posts identified key themes to be addressed in order to improve the healthcare experiences of those impacted by MMC.
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Affiliation(s)
- Shriya Koneru
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sanjeevani Bhavsar
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sangami Pugazenthi
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Gretchen M Koller
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sasidhar Karuparti
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael R Kann
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jennifer M Strahle
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA.
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Chao AS, Jhang LS, Hsieh PCC. Prenatal Diagnosis and Outcomes of Cervical Meningocele and Myelomeningocele. J Med Ultrasound 2024; 32:21-24. [PMID: 38665341 PMCID: PMC11040477 DOI: 10.4103/jmu.jmu_51_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 04/28/2024] Open
Abstract
Prenatal diagnosis of myelomeningocele remains challenging for obstetricians, ultrasonographers, and radiologists, although the increased maternal serum alpha-fetoprotein level aids in the confirmative diagnosis. Fetal cervical myelomeningocele and meningocele are very rare and unique types of myelomeningocele. Prenatal diagnosis of cervical myelomeningocele and meningocele should include the differential diagnosis and association of many intracranial and spino-skeletal pathogenetic variants and genetic diseases, including subependymal nodular heterotopia and Klippel-Feil syndrome. In this report, a comprehensive review of fetal cervical myelomeningocele with its prenatal diagnosis and long-term outcomes is presented.
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Affiliation(s)
- An-Shine Chao
- Department of Obstetrics and Gynecology, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Lan-Sin Jhang
- Department of Obstetrics and Gynecology, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Peter Ching-Chang Hsieh
- Department of Obstetrics and Gynecology, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
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Trigo L, Chmait RH, Llanes A, Catissi G, Eixarch E, Van Speybroeck A, Lapa DA. Revisiting MOMS criteria for prenatal repair of spina bifida: upper gestational-age limit should be raised and assessment of prenatal motor function rather than anatomical level improves prediction of postnatal function. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:53-59. [PMID: 37970655 DOI: 10.1002/uog.27536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES To determine if the lower-extremity neurological motor function level in fetuses with open spina bifida deteriorates within the 4-week interval between a first prenatal motor assessment at around 22 weeks of gestation and a second evaluation, prior to 'late' prenatal surgery, defined as surgery at 26-28 weeks and, in certain situations, up to 30 weeks, and to assess the association between prenatal presurgical motor-function level, anatomical level of the lesion and postnatal motor-function level. METHODS This was a two-center cohort study of 94 singleton fetuses with open spina bifida which underwent percutaneous repair using the skin-over-biocellulose for antenatal fetoscopic repair (SAFER) technique between December 2016 and January 2022. All women underwent two prenatal systematic ultrasound evaluations, approximately 4 weeks apart, with the second one being performed less than 1 week before surgery, and one postnatal evaluation via physical examination within 2 months of birth. Motor-function classification was from spinal level T12 to S1, according to key muscle function. Each leg was analyzed separately; in case of discrepancy between the two legs, the worst motor-function level was considered for analysis. Motor-function-level evaluations were compared with each other and with the anatomical level as observed on ultrasound. Independent predictors of a postnatal reduction in motor-function level were assessed using a logistic regression model. RESULTS Prenatal motor-function level was assessed at a median gestational age of 22.5 (interquartile range (IQR), 20.7-24.3) and 26.7 (IQR, 25.4-27.3) weeks, with a median interval of 4.0 (IQR, 2.4-6.0) weeks. The median gestational age at surgery was 27.0 (IQR, 25.9-27.6) weeks and the postnatal examination was at median age of 0.8 (IQR, 0.3-5.4) months. There was no significant difference in motor-function level between the two prenatal evaluations (P = 0.861). We therefore decided to use the second prenatal evaluation for comparison with postnatal motor function and anatomical level. Overall, prenatal and postnatal motor function evaluations were significantly different from the anatomical level (preoperative assessment, P = 0.0015; postnatal assessment, P = 0.0333). Comparing prenatal with postnatal motor-function level, we found that 87.2% of babies had similar or improved motor function compared with that prior to prenatal surgery. On logistic regression analysis, lower anatomical level of defect and greater difference between anatomical level and prenatal motor-function level were identified as independent predictors of postnatal motor function (odds ratio, 0.237 (95% CI, 0.095-0.588) (P = 0.002) and 3.44 (95% CI, 1.738-6.813) (P < 0.001), respectively). CONCLUSIONS During a 4-week interval between first ultrasound evaluation and late fetal surgical repair of open spina bifida, motor function does not change significantly, suggesting that late repair, ≥ 26 weeks, does not impact negatively on motor-function outcome. Compared with the anatomical level of the lesion, preoperative neurological motor-function assessment via ultrasound is more predictive of postnatal motor function, and should be included in preoperative counseling. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Trigo
- BCNatal - Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Obstetrics and Gynecology Department, Pourtalès Hospital, Neuchâtel, Switzerland
| | - R H Chmait
- Los Angeles Fetal Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A Llanes
- Los Angeles Fetal Surgery, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - G Catissi
- Fetal Therapy Program, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - E Eixarch
- BCNatal - Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - A Van Speybroeck
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - D A Lapa
- Fetal Therapy Program, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Fetal Medicine Department, Hospital Infantil Sabará, São Paulo, Brazil
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Kunpalin Y, Sichitiu J, Krishnan P, Blaser S, Kulkarni AV, Abbasi N, Ryan G, Shinar S, van Mieghem T. Simple prenatal imaging predictors for postnatal cerebrospinal fluid diversion surgery in fetuses undergoing in utero surgery for spina bifida. Prenat Diagn 2023; 43:1605-1613. [PMID: 37975651 DOI: 10.1002/pd.6453] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To determine simple prenatal imaging parameters that can easily be acquired to predict the need for postnatal CSF diversion (PCD) surgery in fetuses undergoing open fetal surgery for open spina bifida (OSB). METHODS All fetuses with OSB that underwent open fetal surgery between June 2017 and June 2021 with available follow-up outcomes were included. Imaging parameters including clivus-supraocciput angle (CSA) on magnetic resonance imaging, transcerebellar diameter (TCD) and lateral ventricle size (Vp) on ultrasound (US), were collected pre- and postoperatively. The requirement for PCD surgery was determined at 1 year of age. The predictive strength of each parameter was determined by Receiver Operating Characteristic curve analysis. RESULTS Among 36 babies eligible for the analyses, 41.7% required PCD by one year of age. Pre-operative Vp (AUC 0.71; 95% confidence interval [CI] 0.54-0.88; p = 0.03), TCD (AUC 0.72; 95% CI 0.55-0.89; p = 0.02) and CSA (AUC 0.72; 95% CI 0.51-0.93; p = 0.04) were fair predictors for PCD surgery. After fetal surgery, TCD (AUC 0.93; 95% CI 0.83-1.00; p < 0.0001) and CSA (AUC 0.94; 95% CI 0.83-1.00; p = 0.0005) were outstanding predictors of PCD, whereas post-operative Vp was a fair predictor (AUC 0.71, 95% CI 0.54-0.88, p = 0.03). CONCLUSION Post-operative CSA and TCD were outstanding predictors for the need for PCD surgery.
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Affiliation(s)
- Yada Kunpalin
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Joanna Sichitiu
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Pradeep Krishnan
- University of Toronto, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Susan Blaser
- University of Toronto, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Abhaya V Kulkarni
- University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Nimrah Abbasi
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Greg Ryan
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Shiri Shinar
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Tim van Mieghem
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Ontario Fetal Centre, Toronto, Ontario, Canada
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Mufti N, Chappell J, Aertsen M, Ebner M, Fidon L, Deprest J, David AL, Melbourne A. Assessment of longitudinal brain development using super-resolution magnetic resonance imaging following fetal surgery for open spina bifida. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:707-720. [PMID: 37161647 PMCID: PMC10947002 DOI: 10.1002/uog.26244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/18/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Prenatal surgery is offered for selected fetuses with open spina bifida (OSB) to improve long-term outcome. We studied the effect of fetal OSB surgery on brain development using advanced magnetic resonance imaging (MRI) techniques to quantify the volume, surface area and shape of cerebral structures and to analyze surface curvature by means of parameters that correspond to gyrification. METHODS We compared MRI data from 29 fetuses with OSB before fetal surgery (mean gestational age (GA), 23 + 3 weeks) and at 1 and 6 weeks after surgery, with that of 36 GA-matched control fetuses (GA range, 21 + 2 to 36 + 2 weeks). Automated super-resolution reconstruction provided three-dimensional isotropic volumetric brain images. Unmyelinated white matter, cerebellum and ventricles were segmented automatically and refined manually, after which volume, surface area and shape parameter (volume/surface area) were quantified. Mathematical markers (shape index (SI) and curvedness) were used to measure gyrification. Parameters were assessed according to lesion type (myelomeningocele vs myeloschisis (MS)), postoperative persistence of hindbrain herniation (HH) and the presence of supratentorial anomalies, namely partial agenesis of the corpus callosum (pACC) and heterotopia (HT). RESULTS Growth in ventricular volume per week and change in shape parameter per week were higher at 6 weeks after surgery in fetuses with OSB compared with controls (median, 2500.94 (interquartile range (IQR), 1689.70-3580.80) mm3 /week vs 708.21 (IQR, 474.50-925.00) mm3 /week; P < 0.001 and 0.075 (IQR, 0.047-0.112) mm/week vs 0.022 (IQR, 0.009-0.042) mm/week; P = 0.046, respectively). Ventricular volume growth increased 6 weeks after surgery in cases with pACC (P < 0.001) and those with persistent HH (P = 0.002). During that time period, the change in unmyelinated white-matter shape parameter per week was decreased in OSB fetuses compared with controls (0.056 (IQR, 0.044-0.092) mm/week vs 0.159 (IQR, 0.100-0.247) mm/week; P = 0.002), particularly in cases with persistent HH (P = 0.011), MS (P = 0.015), HT (P = 0.022), HT with corpus callosum anomaly (P = 0.017) and persistent HH with corpus callosum anomaly (P = 0.007). At 6 weeks postoperatively, despite OSB fetuses having a lower rate of change in curvedness compared with controls (0.061 (IQR, 0.040-0.093) mm-1 /week vs 0.094 (IQR, 0.070-0.146) mm-1 /week; P < 0.001), reversing the trend seen at 1 week after surgery (0.144 (IQR, 0.099-0.236) mm-1 /week vs 0.072 (IQR, 0.059-0.081) mm-1 /week; P < 0.001), gyrification, as determined using SI, appeared to be increased in OSB fetuses overall compared with controls. This observation was more prominent in fetuses with pACC and those with severe ventriculomegaly (P-value range, < 0.001 to 0.006). CONCLUSIONS Following fetal OSB repair, volume, shape and curvedness of ventricles and unmyelinated white matter differed significantly compared with those of normal fetuses. Morphological brain changes after fetal surgery were not limited to effects on the circulation of cerebrospinal fluid. These observations may have implications for postnatal neurocognitive outcome. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N. Mufti
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
| | - J. Chappell
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
| | - M. Aertsen
- Department of RadiologyUniversity Hospitals Katholieke Universiteit (KU) LeuvenLeuvenBelgium
| | - M. Ebner
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
| | - L. Fidon
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
| | - J. Deprest
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- Department of Obstetrics and GynaecologyUniversity Hospitals Katholieke Universiteit (KU) LeuvenLeuvenBelgium
| | - A. L. David
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- Department of Obstetrics and GynaecologyUniversity Hospitals Katholieke Universiteit (KU) LeuvenLeuvenBelgium
- National Institute for Health and Care Research University College London Hospitals Biomedical Research CentreLondonUK
| | - A. Melbourne
- School of Biomedical Engineering and Imaging Sciences (BMEIS)King's College LondonLondonUK
- Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
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Akbas H, Guven ESG, Guven S, Kizilirmak R, Albayrak M, Aydogan Z, Kul S. Evaluation of the height of the corpus callosum body region in fetal meningomyelocele malformation. J Gynecol Obstet Hum Reprod 2023; 52:102619. [PMID: 37295771 DOI: 10.1016/j.jogoh.2023.102619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE To investigate height of the corpus callosum (CC) in order to describe the corpus callosum anomalies in fetuses with meningomyelocele (MMC) and compare these findings with the corpus callosum of healthy fetuses. METHODS In this study, fetal MRI examinations were performed on 44 fetal MMC malformation cases. As the control group, 34 fetal MRI examinations, which were anatomically normal, were evaluated retrospectively. In the study group, lateral ventricle diameter, the level and diameter of the MMC defect, and CC height were measured. In the control group, CC height and lateral ventricular diameter were measured. RESULTS The mean CC body height was 1.36 mm in the study group, and 2.48 mm in the control group. The height of the CC body region of the study population was inclined to be thinner compared with the control population (p<0.001). CONCLUSIONS The fact that the height of the CC body region was found to be thinner in fetal MRI in cases of MMC compared with normal fetuses suggests that various callosal anomalies are uncertain, investigation of additional callosal anomalies may be beneficial in the decision for the continuation of pregnancy, and termination or intrauterine surgery in cases with MMC. Further large case group studies are needed.
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Affiliation(s)
- Humeyra Akbas
- Department of Perinatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.
| | | | - Suleyman Guven
- Department of Gynecology and Obstetrics, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Rukiye Kizilirmak
- Department of Perinatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Mehmet Albayrak
- Department of Perinatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Zeynep Aydogan
- Department of Radiology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Sibel Kul
- Department of Radiology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
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9
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Kunpalin Y, Sichitiu J, Krishan P, Blaser S, Shannon P, Van Mieghem T, Shinar S. Midline suprapineal pseudocyst in brain of fetuses with open spina bifida. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:383-390. [PMID: 37058393 DOI: 10.1002/uog.26221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Recently, it was noted that fetuses with open spina bifida (OSB) may have a midline cystic structure evident on ultrasound. Our aims were to determine the prevalence of this cystic structure, shed light on its pathophysiology and investigate the association between its presence and other characteristic brain findings in fetuses with OSB. METHODS This was a single-center retrospective study of all fetuses with OSB and available cineloop images in the axial plane referred to the Ontario Fetal Centre, Toronto, Canada, between June 2017 and May 2022. Ultrasound and magnetic resonance imaging (MRI) data obtained between 18 + 0 and 25 + 6 weeks were reviewed in search of a midline cystic structure. Pregnancy and lesion characteristics were collected. Transcerebellar diameter (TCD), clivus-supraocciput angle (CSA) and additional brain abnormalities (abnormal cavum septi pellucidi (CSP), abnormal corpus callosum (CC) and periventricular nodular heterotopia (PNH)) were assessed. In cases of in-utero repair, imaging findings were reviewed postoperatively. In cases of termination, neuropathological findings were reviewed, if available. RESULTS Of 76 fetuses with OSB, 56 (73.7%) had a suprapineal cystic structure on ultrasound. The percentage of agreement between ultrasound and MRI detection was 91.5% (Cohen's kappa coefficient, 0.78 (95% CI, 0.57-0.98)). Brain autopsy in terminated cases revealed a dilatation of the posterior third ventricle, with redundant tela choroidea and arachnoid forming the membranous roof of the third ventricle, anterior and superior to the pineal gland. A cyst wall could not be identified, indicating that the structure was a pseudocyst. The presence of the pseudocyst was associated with a smaller CSA (pseudocyst absent, 62.11 ± 9.60° vs pseudocyst present, 52.71 ± 8.22°; P = 0.04). When the pseudocyst was present, its area was correlated inversely with TCD (r, -0.28 (95% CI, -0.51 to -0.02); P = 0.04). Fetal surgery did not have any impact on the growth rate of the pseudocyst (fetal surgery, 5.07 ± 3.29 mm2 /week vs expectant management, 4.35 ± 3.17 mm2 /week; P = 0.58). The presence of the pseudocyst was not associated with abnormal CSP, CC or presence of PNH. None of the cases with available postnatal follow-up required surgical procedure related to the pseudocyst. CONCLUSIONS Approximately 75% of all OSB cases have a suprapineal pseudocyst. Its presence is associated with the degree of hindbrain herniation but not with abnormalities of the CSP and CC or presence of PNH. Thus, it should not be regarded as additional brain pathology and should not preclude fetuses from undergoing fetal surgery for OSB. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- Y Kunpalin
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - J Sichitiu
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - P Krishan
- Department of Diagnostic Imaging, Hospital for Sick Children and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - S Blaser
- Department of Diagnostic Imaging, Hospital for Sick Children and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - P Shannon
- Division of Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - T Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
| | - S Shinar
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
- Ontario Fetal Centre, Toronto, Canada
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10
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Keil C, Köhler S, Sass B, Schulze M, Kalmus G, Belfort M, Schmitt N, Diehl D, King A, Groß S, Sutton CD, Joyeux L, Wege M, Nimsky C, Whitehead WE, Uhl E, Huisman TAGM, Neubauer BA, Weber S, Hummler H, Axt-Fliedner R, Bedei I. Implementation and Assessment of a Laparotomy-Assisted Three-Port Fetoscopic Spina Bifida Repair Program. J Clin Med 2023; 12:5151. [PMID: 37568553 PMCID: PMC10419476 DOI: 10.3390/jcm12155151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Open spina bifida (OSB) is a congenital, non-lethal malformation with multifactorial etiology. Fetal therapy can be offered under certain conditions to parents after accurate prenatal diagnostic and interdisciplinary counseling. Since the advent of prenatal OSB surgery, various modifications of the original surgical techniques have evolved, including laparotomy-assisted fetoscopic repair. After a two-year preparation time, the team at the University of Giessen and Marburg (UKGM) became the first center to provide a three-port, three-layer fetoscopic repair of OSB via a laparotomy-assisted approach in the German-speaking area. We point out that under the guidance of experienced centers and by intensive multidisciplinary preparation and training, a previously described and applied technique could be transferred to a different setting.
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Affiliation(s)
- Corinna Keil
- Department of Prenatal Medicine and Fetal Therapy, Philipps University, 35043 Marburg, Germany
| | - Siegmund Köhler
- Department of Prenatal Medicine and Fetal Therapy, Philipps University, 35043 Marburg, Germany
| | - Benjamin Sass
- Department of Neurosurgery, Philipps University, 35043 Marburg, Germany
| | - Maximilian Schulze
- Department of Neuroradiology, Philipps University, 35043 Marburg, Germany
| | - Gerald Kalmus
- Department of Anesthesiology and Intensive Care Medicine, Philipps University, 35043 Marburg, Germany
| | - Michael Belfort
- Department of Obstetrics and Gynecology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Fetal Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Nicolas Schmitt
- Department of Anesthesiology and Intensive Care Medicine, Philipps University, 35043 Marburg, Germany
| | - Daniele Diehl
- Department of Pediatric Neurology, Justus-Liebig University Giessen, 35392 Giessen, Germany
| | - Alice King
- Texas Children’s Fetal Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
- Division of Pediatric Surgery, Department of Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Stefanie Groß
- Department of Pediatric Neurology, Justus-Liebig University Giessen, 35392 Giessen, Germany
| | - Caitlin D. Sutton
- Department of Pediatric Anesthesiology, Perioperative, and Pain Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Luc Joyeux
- Texas Children’s Fetal Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
- Division of Pediatric Surgery, Department of Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Mirjam Wege
- Division of Neonatology, University Children’s Hospital Marburg, 35043 Marburg, Germany
| | | | - Wiliam E. Whitehead
- Texas Children’s Fetal Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Neurosurgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Eberhard Uhl
- Department of Neurosurgery, Justus-Liebig University, 35390 Giessen, Germany
| | - Thierry A. G. M. Huisman
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Bernd A. Neubauer
- Department of Pediatric Neurology, Justus-Liebig University Giessen, 35392 Giessen, Germany
| | - Stefanie Weber
- Division of Pediatric Nephrology and Transplantation, University Children’s Hospital Marburg, 35043 Marburg, Germany
| | - Helmut Hummler
- Division of Neonatology, University Children’s Hospital Marburg, 35043 Marburg, Germany
| | - Roland Axt-Fliedner
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University Giessen, 35390 Giessen, Germany
| | - Ivonne Bedei
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University Giessen, 35390 Giessen, Germany
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11
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Deprest T, Fidon L, De Keyzer F, Ebner M, Deprest J, Demaerel P, De Catte L, Vercauteren T, Ourselin S, Dymarkowski S, Aertsen M. Application of Automatic Segmentation on Super-Resolution Reconstruction MR Images of the Abnormal Fetal Brain. AJNR Am J Neuroradiol 2023; 44:486-491. [PMID: 36863845 PMCID: PMC10084897 DOI: 10.3174/ajnr.a7808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 02/06/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND AND PURPOSE Fetal brain MR imaging is clinically used to characterize fetal brain abnormalities. Recently, algorithms have been proposed to reconstruct high-resolution 3D fetal brain volumes from 2D slices. By means of these reconstructions, convolutional neural networks have been developed for automatic image segmentation to avoid labor-intensive manual annotations, usually trained on data of normal fetal brains. Herein, we tested the performance of an algorithm specifically developed for segmentation of abnormal fetal brains. MATERIALS AND METHODS This was a single-center retrospective study on MR images of 16 fetuses with severe CNS anomalies (gestation, 21-39 weeks). T2-weighted 2D slices were converted to 3D volumes using a super-resolution reconstruction algorithm. The acquired volumetric data were then processed by a novel convolutional neural network to perform segmentations of white matter and the ventricular system and cerebellum. These were compared with manual segmentation using the Dice coefficient, Hausdorff distance (95th percentile), and volume difference. Using interquartile ranges, we identified outliers of these metrics and further analyzed them in detail. RESULTS The mean Dice coefficient was 96.2%, 93.7%, and 94.7% for white matter and the ventricular system and cerebellum, respectively. The Hausdorff distance was 1.1, 2.3, and 1.6 mm, respectively. The volume difference was 1.6, 1.4, and 0.3 mL, respectively. Of the 126 measurements, there were 16 outliers among 5 fetuses, discussed on a case-by-case basis. CONCLUSIONS Our novel segmentation algorithm obtained excellent results on MR images of fetuses with severe brain abnormalities. Analysis of the outliers shows the need to include pathologies underrepresented in the current data set. Quality control to prevent occasional errors is still needed.
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Affiliation(s)
- T Deprest
- From the Department of Radiology (T.D., F.D.K., P.D., S.D., M.A.)
| | - L Fidon
- School of Biomedical Engineering and Imaging Sciences (L.F., M.E., T.V., S.O.), King's College London, London, UK
| | - F De Keyzer
- From the Department of Radiology (T.D., F.D.K., P.D., S.D., M.A.)
| | - M Ebner
- School of Biomedical Engineering and Imaging Sciences (L.F., M.E., T.V., S.O.), King's College London, London, UK
- Department of Medical Physics and Biomedical Engineering (M.E., T.V.), University College London, London, UK
| | - J Deprest
- Gynaecology and Obstetrics (J.D., L.D.C., T.V.), University Hospitals Leuven, Belgium
- Institute for Women's Health (J.D.)
| | - P Demaerel
- From the Department of Radiology (T.D., F.D.K., P.D., S.D., M.A.)
| | - L De Catte
- Gynaecology and Obstetrics (J.D., L.D.C., T.V.), University Hospitals Leuven, Belgium
| | - T Vercauteren
- Gynaecology and Obstetrics (J.D., L.D.C., T.V.), University Hospitals Leuven, Belgium
- School of Biomedical Engineering and Imaging Sciences (L.F., M.E., T.V., S.O.), King's College London, London, UK
- Department of Medical Physics and Biomedical Engineering (M.E., T.V.), University College London, London, UK
| | - S Ourselin
- School of Biomedical Engineering and Imaging Sciences (L.F., M.E., T.V., S.O.), King's College London, London, UK
| | - S Dymarkowski
- From the Department of Radiology (T.D., F.D.K., P.D., S.D., M.A.)
| | - M Aertsen
- From the Department of Radiology (T.D., F.D.K., P.D., S.D., M.A.)
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12
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Advances in Fetal Surgical Repair of Open Spina Bifida. Obstet Gynecol 2023; 141:505-521. [PMID: 36735401 DOI: 10.1097/aog.0000000000005074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023]
Abstract
Spina bifida remains a common congenital anomaly of the central nervous system despite national fortification of foods with folic acid, with a prevalence of 2-4 per 10,000 live births. Prenatal screening for the early detection of this condition provides patients with the opportunity to consider various management options during pregnancy. Prenatal repair of open spina bifida, traditionally performed by the open maternal-fetal surgical approach through hysterotomy, has been shown to improve outcomes for the child, including decreased need for cerebrospinal fluid diversion surgery and improved lower neuromotor function. However, the open maternal-fetal surgical approach is associated with relatively increased risk for the patient and the overall pregnancy, as well as future pregnancies. Recent advances in minimally invasive prenatal repair of open spina bifida through fetoscopy have shown similar benefits for the child but relatively improved outcomes for the pregnant patient and future childbearing.
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13
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Avesani G, Perazzolo A, Elia L, Anghelone AG, Gaudino S, Russo L, Genco E, Di Paola V, Massimi L, De Santis M, Tamburrini G, Manfredi R. Fetal MRI prior to intrauterine surgery of open neural tube defects: What does the radiologist need to know. LA RADIOLOGIA MEDICA 2023; 128:113-124. [PMID: 36525177 DOI: 10.1007/s11547-022-01579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
The management of myelomeningocele study trial showed significant prognostic improvement in fetal repair before 26 weeks of gestation. Hence, surgery in utero represents the best treatment option for open-neural tube defects (NTDs). Fetal surgery of open-NTDs has specific inclusion and exclusion criteria, which can be adequately studied with fetal MRI. The main concern: the spine (spinal defects other than Myelomeningocele and Myeloschisis, the level of the lesion higher than T1 or lower than S1 and the degree of kyphosis ≥ 30°), the skull/brain (no cerebellum herniation and Chiari II malformation and the presence of any intracranial abnormality unrelated to open NTDs), the uterus (cervix length less than 2 cm, multiple gestations and placental and uterine abnormalities) and any other fetal abnormality not attributed to spinal defect. In this review, we describe the fundamental role of fetal MRI in supporting therapeutic decisions in pre-surgery intrauterine planning through the accurate and comprehensive description of findings, providing a proposal of a structured report. In addition, we describe how post-surgical MRI is important in investigating the effectiveness of surgery and detecting repairing complications.
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Affiliation(s)
- Giacomo Avesani
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | | | - Lorenzo Elia
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Simona Gaudino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Russo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Enza Genco
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Valerio Di Paola
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Luca Massimi
- Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | - Marco De Santis
- Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | - Gianpiero Tamburrini
- Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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14
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Aertsen M. The Role of Fetal Brain Magnetic Resonance Imaging in Current Fetal Medicine. J Belg Soc Radiol 2022; 106:130. [PMID: 36569393 PMCID: PMC9756908 DOI: 10.5334/jbsr.3000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
In open spina bifida we studied the use of MRI for the assessment of the posterior fossa and prevalence of supratentorial anomalies before and after in utero repair. New postprocessing techniques were applied to evaluate fetal brain development in this population compared to controls. In fetuses with congenital diaphragmatic hernia, we evaluated the brain development in comparison to controls. Diffusion weighted imaging was applied to study difference between fetuses with proven first trimester cytomegalovirus infection and controls. Finally, we investigated the value of third trimester fetal brain MRI after treatment for complicated monochorionic diamniotic pregnancies.
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15
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Fetoscopic Myelomeningocele Repair with Complete Release of the Tethered Spinal Cord Using a Three-Port Technique: Twelve-Month Follow-Up-A Case Report. Diagnostics (Basel) 2022; 12:diagnostics12122978. [PMID: 36552985 PMCID: PMC9776674 DOI: 10.3390/diagnostics12122978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
Open spina bifida is one of the most common congenital defects of the central nervous system. Open fetal surgery, which is one of the available therapeutic options, remains the gold standard for prenatal repairs. Fetoscopic closure may lower the number of maternal complications associated with open fetal surgery. Regardless of the approach, the outcome may be compromised by the development of tethered spinal cord (TSC) syndrome. At 24.2 weeks of gestation, a primipara was admitted due to fetal myelomeningocele and was deemed eligible for fetoscopic repair. Fetal surgery was performed at 25.0 weeks of gestation. It was the first complete untethering of the spinal cord and anatomic reconstruction (dura mater, spinal erectors, skin) achieved during a fetoscopic repair of spina bifida. Cesarean section due to placental abruption was performed at 31.1 weeks of gestation. VP shunting, with no need for revision, was performed at 5 weeks postdelivery due to progressing ventriculomegaly. No clinical or radiological signs of secondary tethering were observed. Neurological examination at 11 months postdelivery revealed cranial nerves without any signs of damage, axial hypotonia, decreased muscle tone in the lower extremities, and absent pathological reflexes. Motor development was slightly retarded. Complete untethering of the neural structures should always be performed, regardless of the surgical approach, as it is the only course of action that lowers the risk for developing secondary TSC.
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