Fetal surgery for spina bifida in Zurich: results from 150 cases

• Published in: Pediatric surgery international Vol. 37; no. 3; pp. 311 - 316
• Main Authors: Moehrlen, Ueli, Ochsenbein, Nicole, Vonzun, Ladina, Mazzone, Luca, Horst, Maya, Schauer, Sonja, Wille, David Alexander, Hagmann, Cornelia, Kottke, Raimund, Grehten, Patrice, Casanova, Barbara, Strübing, Nele, Moehrlen, Theres, Tharakan, Sasha, Padden, Beth, Bassler, Dirk, Zimmermann, Roland, Meuli, Martin
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2021; Springer Nature B.V
• Subjects: Bladder; Cysts; Fetuses; Gestational age; Hydrocephalus; Medicine; Medicine & Public Health; Original Article; Pathogenesis; Pediatric Surgery; Pediatrics; Postpartum period; Spina bifida; Spinal cord; Surgery; Ultrasonic imaging; Zurich Switzerland; Fetal surgery; In utero surgery; Spina bifida; Myelomeningocele; Myeloschisis; Outcome
• ISSN: 0179-0358; 1437-9813
• DOI: 10.1007/s00383-020-04824-8

Purpose
Over the past 10 years, over 150 fetal spina bifida surgeries were performed at the Zurich Center for Fetal Diagnosis and Therapy. This study looks at surrogates for success and failure of this approach.
Methods
We focused on key outcome parameters including hydrocephalus shunt rate at one year, bladder control at 4, independent ambulation at 3 years, and maternal, fetal, and neonatal complications.
Results
From the first 150 patients undergoing fetal surgery for spina bifida, 148 (98.7%) were included in the study. Maternal–fetal surgery was uneventful in 143/148 (97%) cases. Intraoperative problems included resuscitation in 4/148 fetuses (2.7%). 1/148 fetuses (0.7%) died on postoperative day 4. Maternal complications included chorioamniotic membrane separation in 22/148 (15%), lung embolism in 3/148 (2.1%), chorioamnionitis in 2/148 (1.4%), AV-block III and uterine rupture in 1/148 each (0.7%). 1/148 (0.7%) newborn death was recorded. Hindbrain herniation was identified preoperatively in 132/148 (90%) fetuses and resolved completely in 119/132 (90%). At one year, 39/106 (37%) children had required a CSF diversion. At 4 years, 4/34 patients (12%) had normal bladder control. At 3 years, 48/57 (84%) walked independently.
Conclusion
A majority of patients benefitted from prenatal intervention, in that the shunt rate was lower and the rates of continent and walking patients were higher than reported with postnatal care.