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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Comparison of neurosurgical interventions after fetoscopic prenatal and microsurgical postnatal coverage of spina bifida aperta

Vergleich der neurochirurgischen Interventionen nach fetoskopischem pränatalen und mikrochirurgischem postnatalen Verschluss bei Kindern mit Spina bifida

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  • presenting/speaker Malgorzata Kolodziej - UKGM Gießen, Neurochirurgie, Gießen, Deutschland
  • Frank Patrick Schwarm - UKGM Gießen, Neurochirurgie, Gießen, Deutschland
  • Katharina Graf - UKGM Gießen, Neurochirurgie, Gießen, Deutschland
  • Harald Ehrhardt - UKGM, Abteilung Allgemeine Pädiatrie & Neonatologie, Gießen, Deutschland
  • Marco Stein - UKGM Gießen, Neurochirurgie, Gießen, Deutschland
  • Bernd A. Neubarer - UKGM, Klinik für Kinderneurologie und Sozialpädiatrie, Gießen, Deutschland
  • Eberhard Uhl - UKGM Gießen, Neurochirurgie, Gießen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV026

doi: 10.3205/19dgnc038, urn:nbn:de:0183-19dgnc0385

Published: May 8, 2019

© 2019 Kolodziej et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: To evaluate the need for secondary neurosurgical intervention after fetoscopic and postnatal microsurgical coverage of spina bifida aperta (SBA). We evaluated also the wound infection as a role of surgical timing after SBA repair in the second cohort of postnatally covered SBA.

Methods: Patients who suffered from SBA and underwent fetoscopic or postnatal coverage between 2010–2018 were included in this retrospective analysis. Neurosurgical procedures were classified into three types: re-coverage of the SBA within the first 3 months after birth, ventriculoperiteonal shunt placement for treatment of hydrocephalus and decompressive surgery for Chiari malformation within the first year of life.

Results: A total of 98 patients were included, 71 fetuses after fetoscopic patch coverage of SBA (between 21±0 and 29±1weeks of gestation) and 27 newborns, who underwent microsurgical coverage within 1–3 days after birth.

Following fetoscopic patch coverage surgical revision of SBA in the early postnatal period was necessary in 35% of patients. The most common cause was a cerebrospinal fluid leak (35%). Ventriculoperitoneal shunt placement within the first year was required in 45% cases. Three (4%) infants needed Chiari decompressive surgery for Chiari malformation because of syringomyelia.

In the children that had coverage of their SBA postnatally surgical revisions were necessary in 18.5% of the cases. Ventriculoperitoneal shunt placement was performed in 59.2% and Chiari decompression in 3.7% of cases.

Conclusion: Second surgery after fetoscopic patch coverage of SBA was higher than after postnatal microsurgical treatment. In contrast, the need for shunting seems to be lower in the fetoscopic group. No difference was found in the number of surgeries for Chiari malformation.