Prenatal and postnatal MRI findings in open spinal dysraphism following intrauterine repair via open versus fetoscopic surgical techniques. (13th August 2019)

• Record Type: Journal Article
• Authors: Nagaraj, Usha D.; Bierbrauer, Karin S.; Stevenson, Charles B.; Peiro, Jose L.; Lim, Foong Yen; Habli, Mounira A.; Kline‐Fath, Beth M.
• Is Part Of: Prenatal diagnosis. Volume 40:Number 1(2020)
• Page Start: 49
• Page End: 57
• Publication Date: 2019-08-13
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.5540
• Languages: English
• ISSNs: 0197-3851

Abstract

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. Abstract : Fetoscopic repair of open spinal dysraphisms is a promising technique which allows for closure of the fetal spinal dysraphic defect with an associated reduction in maternal and uterine trauma when compared with the open hysterotomy technique. Fetal and postnatal MRI are essential in the initial workup, prenatal management, counseling, perinatal management, and follow‐up of these patients. What does this study add? There is no significant difference in postnatal MRI findings in the brain and spine between fetuses undergoing open versus fetoscopic prenatal repair of open spinal dysraphisms. Intracranial hemorrhage can be diagnosed prenatally on EPI blood sequence and is not infrequently seen postnatally in these patients. Accurate prenatal‐level assignment in sacral spinal dysraphisms utilizing both fetal MRI and/or fetal ultrasound can be challenging.