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66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Friendship Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

7. - 10. Juni 2015, Karlsruhe

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Postnatal neurosurgical interventions after fetoscopic surgery for spina bifida aperta

Meeting Abstract

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  • Katharina Graf - Department of Neurosurgery, Justus-Liebig-University, Gießen, Germany
  • Frederic A. Wanis - Department of Neurosurgery, Justus-Liebig-University, Gießen, Germany
  • Thomas Kohl - German Center for Fetal Surgery & Minimally Invasive Therapy (DZFT), Justus-Liebig-University, Gießen, Germany
  • Marcus H. T. Reinges - Department of Neurosurgery, Justus-Liebig-University, Gießen, Germany
  • Eberhard Uhl - Department of Neurosurgery, Justus-Liebig-University, Gießen, Germany
  • Malgorzata Kolodziej - Department of Neurosurgery, Justus-Liebig-University, Gießen, Germany

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocDI.16.08

doi: 10.3205/15dgnc185, urn:nbn:de:0183-15dgnc1850

Veröffentlicht: 2. Juni 2015

© 2015 Graf et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: The goal of the study was to evaluate the need for postnatal neurosurgical interventions after fetoscopic patch coverage of spina bifida aperta (SBA).

Method: Retro- and partial prospective analysis of a cohort of 71 fetuses who underwent minimally-invasive fetoscopic patch coverage of SBA between 21+0 and 29+1 weeks+days of gestation. Localization of the SBA was lumbosacral (59), lumbar (6), thoracic (3) and sacral (2). Neurosurgical procedures were divided in secondary coverage of the SBA within the first three months after birth and treatment of associated hydrocephalus within the first year of life.

Results: A total of 20/71 (28.2%) patients underwent early postnatal neurosurgical interventions. Re-coverage of the SBA was performed because of CSF leaks in 7/20 (35%), adhesions with functional deterioration in 3/20 (15%), incomplete coverage in 5/20 (25%) and skin defect in 5/20 (25%) of cases. Ventriculo-peritoneal shunting within one year was required in 32 cases (45%) and was preceded by ventriculostomy in two. Three children needed Chiari decompression surgery in the first 12 month after birth because of syringomyelia or gait disturbance.

Conclusions: Fetoscopic patch coverage of SBA may require postnatal re-coverage in some cases. In most cases, conservative wound treatment shows good results without the need for neurosurgical intervention. The low one-year-shunt rate is comparable to the data of the MOMS trial and lower compared to the data published of patients with postnatal coverage of the spina bifida.