gms | German Medical Science

Objective: The goal of the study was the evaluation of the postnatal need for neurosurgical procedures after fetoscopic patch coverage of spina bifida.

Method: In a retrospective cohort study, 33 newborns (male 15 / female 18) after minimally-invasive fetoscopic patch coverage of spina bifida were included over a 1.5 year period and followed up throughout their neurosurgical treatment. The fetoscopic procedures were performed between 21+1 and 27+2 weeks+days of gestation. Localisation of the SBA was lumbosacral (31), lumbar (1) and sacral (1). Neurosurgical procedures were divided in secondary coverage and treatment of associated hydrocephalus. In addition, the quality of leg function was assessed before and after postnatal surgery.

Results: 21 of these newborns needed postnatal neurosurgical attention. A re-coverage of the SBA was performed because of adhesions in four, patch leaks in four and incomplete coverage in five patients. These cases correlated to difficult dissection or large defects because of fetal lie, maternal obesity and/or anterior placenta. Hydrocephalus required ventriculoperitoneal-shunting in 9 and a ventriculo-cisternostomie in 1 case. Worsening of leg function was not observed after postnatal reintervention; in two thirds of patients, leg strength remained normal or near normal. Three of the analyzed newborns were excluded of the later follow-up because of incomplete diagnostic findings.

Conclusions: Percutaneous fetoscopic-patch coverage of spina bifida was followed by postnatal re-coverage in 40% of cases. The early shunt rate was 30%. In our series, the deterioration of leg function was not observed. Localisation of SBA and time of fetoscopic coverage had no effect on neurosurgical procedure.