| Autor: |
Kunpalin, Yada, Sichitiu, Joanna, Krishnan, Pradeep, Blaser, Susan, Kulkarni, Abhaya V., Abbasi, Nimrah, Ryan, Greg, Shinar, Shiri, van Mieghem, Tim |
| Zdroj: |
Prenatal Diagnosis; Dec2023, Vol. 43 Issue 13, p1605-1613, 9p |
| Abstrakt: |
Objectives: To determine simple prenatal imaging parameters that can easily be acquired to predict the need for postnatal CSF diversion (PCD) surgery in fetuses undergoing open fetal surgery for open spina bifida (OSB). Methods: All fetuses with OSB that underwent open fetal surgery between June 2017 and June 2021 with available follow‐up outcomes were included. Imaging parameters including clivus‐supraocciput angle (CSA) on magnetic resonance imaging, transcerebellar diameter (TCD) and lateral ventricle size (Vp) on ultrasound (US), were collected pre‐ and postoperatively. The requirement for PCD surgery was determined at 1 year of age. The predictive strength of each parameter was determined by Receiver Operating Characteristic curve analysis. Results: Among 36 babies eligible for the analyses, 41.7% required PCD by one year of age. Pre‐operative Vp (AUC 0.71; 95% confidence interval [CI] 0.54–0.88; p = 0.03), TCD (AUC 0.72; 95% CI 0.55–0.89; p = 0.02) and CSA (AUC 0.72; 95% CI 0.51–0.93; p = 0.04) were fair predictors for PCD surgery. After fetal surgery, TCD (AUC 0.93; 95% CI 0.83–1.00; p < 0.0001) and CSA (AUC 0.94; 95% CI 0.83–1.00; p = 0.0005) were outstanding predictors of PCD, whereas post‐operative Vp was a fair predictor (AUC 0.71, 95% CI 0.54–0.88, p = 0.03). Conclusion: Post‐operative CSA and TCD were outstanding predictors for the need for PCD surgery. Key points: What is already known about this topic? Fetuses with preoperative severe ventriculomegaly (≥15 mm) have a 79% risk of requiring postnatal shunt placement.Persistence of hindbrain herniation on magnetic resonance imaging (MRI) 6 weeks after fetal surgery for open spina bifida (OSB) predicts the need for postnatal cerebrospinal fluid (CSF) diversion surgery. What does this study add? Fetal clivus‐supraocciput angle (CSA) measured on MRI and transcerebellar diameter measured on ultrasound after fetal surgery OSB have excellent predictive value for requiring postnatal CSF diversion (PCD) surgery at 1 year of age.Preoperative transcerebellar diameter has a fair predictive value for the requirement of PCD surgery at 1 year of age. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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