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Long-Term Imaging Follow-up from the Management of Myelomeningocele Study
E George1, C MacPherson2, S Pruthi3
1From the Departments of Radiology and Biomedical Imaging (E.G., O.A.G.).
Insights
Prenatal repair of myelomeningocele leads to better long-term brain development. This surgery improves Chiari II malformation outcomes and reduces hindbrain abnormalities compared to postnatal repair.
Area of Science:
- Neuroscience
- Developmental Biology
- Pediatric Surgery
Background:
- Prenatal myelomeningocele repair shows short-term benefits like reduced hydrocephalus and improved Chiari II malformation.
- Long-term imaging outcomes comparing prenatal and postnatal repair require further investigation.
Purpose of the Study:
- To evaluate long-term (school-age) brain imaging findings in patients who underwent prenatal versus postnatal myelomeningocele repair.
- To compare the persistence and resolution of Chiari II malformation features between the two surgical groups.
Main Methods:
- Analysis of brain MR imaging at school age for patients from the Management of Myelomeningocele Study.
- Comparison of posterior fossa and supratentorial abnormalities between 66 prenatal and 63 postnatal repair cases.
- Assessment of changes in imaging findings from fetal to school-age MRIs.
Main Results:
- Prenatal repair was linked to a normal fourth ventricle position and reduced hindbrain herniation, cerebellar herniation, tectal beaking, and brainstem distortion at school age (P < .01).
- No significant differences in supratentorial abnormalities (e.g., corpus callosal, gyral abnormalities) were observed between groups (P > .05).
- Higher rates of resolution for brainstem kinking, tectal beaking, and cerebellar/hindbrain herniation were seen in the prenatal repair group (P < .02).
Conclusions:
- Prenatal myelomeningocele repair offers persistent improvements in posterior fossa imaging related to Chiari II malformation at school age.
- These findings support prenatal intervention for better long-term neurological outcomes in myelomeningocele patients.
Background And Purpose:
Short-term results demonstrate that prenatal repair of a myelomeningocele is associated with a reduction in hydrocephalus and an increased likelihood of the reversal of Chiari II malformations compared with postnatal repair. The purpose of this study was to identify the long-term imaging findings at school age among subjects who underwent pre- versus postnatal repair of a myelomeningocele.
Materials And Methods:
A subset of subjects enrolled in the Management of Myelomeningocele Study who underwent either prenatal (n = 66) or postnatal (n = 63) repair of a lumbosacral myelomeningocele and had follow-up brain MR imaging at school age were included. The prevalence of posterior fossa features of Chiari II malformation and supratentorial abnormalities and the change in these findings from fetal to school-age MR imaging were compared between the 2 groups.
Results:
Prenatal repair of a myelomeningocele was associated with higher rates of normal location of fourth ventricle and lower rates of hindbrain herniation, cerebellar herniation, tectal beaking, brainstem distortion, and kinking at school age compared with postnatal repair (all P < .01). Supratentorial abnormalities, including corpus callosal abnormalities, gyral abnormalities, heterotopia, and hemorrhage, were not significantly different between the 2 groups (all P > .05). The rates of resolution of brainstem kinking, tectal beaking, cerebellar and hindbrain herniation, and normalization of fourth ventricle size from fetal to school age MR imaging were higher among the prenatal compared with postnatal surgery group (all, P < .02).
Conclusions:
Prenatal repair of a myelomeningocele is associated with persistent improvement in posterior fossa imaging findings of Chiari II malformation at school age compared with postnatal repair.
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