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Fetus

Poster Session 1

(138) Late prenatal repair of open spina bifida (OSB) and postnatal cerebrospinal fluid (CSF) diversion

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Risk factors for postnatal CSF diversion after prenatal OSB repair were identified in a meta-analysis from 2002-2021. These included lateral ventricle ≥ 15 mm, lesion level T12-L2, myeloschisis, and gestational age (GA) at surgery ≥ 25 weeks. The aim of this study was to assess the risk factors for CSF diversion by 12 months of life after percutaneous fetoscopic OSB repair performed ≥ 25 weeks’ gestation.

Study Design: This was a prospective study of patients who underwent percutaneous fetoscopic OSB repair from 2019-2023 at GA ≥ 25 weeks. The decision to offer CSF diversion was based on postnatal MRI and clinical findings. Preoperative, operative, and neonatal characteristics were examined as predictors for a CSF diversion procedure (ventriculoperitoneal shunt or endoscopic third ventriculostomy) within the first 12 months of life, using bivariate analyses and multiple logistic regression models.

Results: Of 47 patients that had prenatal repair ≥ 25 weeks’ gestation, some degree of hindbrain herniation (HBH) reversal was noted at birth in 41 (87.2%) and complete HBH reversal in 22 (46.8%). CSF diversion by 12 months of age was required in 14 cases (29.8%). In bivariate analysis (p< 0.05), both fetal ventricular measurement ≥ 15 mm prior to surgery and lack of complete hindbrain HBH reversal at neonatal assessment were associated with a CSF diversion procedure. Multiple logistic regression showed that cases with a lateral ventricle ≥ 15 mm were 7 times more likely to have CSF diversion (OR 7.63, 95%CI 1.52-38.20, p = 0.0134), and cases lacking complete HBH reversal were 5 times more likely to have CSF diversion (OR 5.25, 95%CI 1.07-25.83, p = 0.0414).

Conclusion: Percutaneous fetoscopic repair of OSB at 25-27 weeks was associated with a 29.8% risk of postnatal CSF diversion at 12 months of life. This compares favorably to the ~40% risk in the published literature in which prenatal repair is typically done £ 25 weeks. Further study is required to assess the risks/benefits of postponing prenatal repair of OSB beyond 25 weeks’ gestation.