Arnold-Chiari Malformations in Pediatric Patients After Fetal Surgery for Meningomyelocele
Miroslava Kohútková1, František Horn1
1Department of Paediatric Surgery, Faculty of Medicine, Comenius University of Bratislava, 833 40 Bratislava, Slovakia.
Insights
Fetal surgery for meningomyelocele (MMC) reduces Chiari malformations and hydrocephalus. Prenatal MMC repair improves functional outcomes, though craniocervical decompression needs vary by lesion level.
Area of Science:
- Pediatric Neurosurgery
- Fetal Medicine
- Developmental Biology
Background:
- Fetal surgery for meningomyelocele (MMC) aims to decrease Arnold-Chiari malformations, hydrocephalus, and shunt dependency.
- Improved ambulatory status is a key goal of prenatal MMC intervention.
Purpose of the Study:
- To evaluate the clinical outcomes and neuroimaging findings in patients who underwent fetal surgery for MMC.
- To compare the results with established benchmarks like the Management of Myelomeningocele Study (MOMS).
Main Methods:
- Retrospective analysis of clinical data and MRI parameters from eight patients treated between 2016-2020.
- Descriptive statistics were used to summarize findings, with neurosurgical results presented as percentages.
Main Results:
- All patients had prenatal Chiari II malformation; 87.5% at 12 months. Craniocervical decompression was needed in 25%, and 50% developed shunt-dependent hydrocephalus.
- 87.5% of patients achieved functional levels exceeding expected ambulatory status.
Conclusions:
- Prenatal MMC surgery is linked to lower rates of Chiari malformations and hydrocephalus.
- Lesion level did not correlate with the need for craniocervical decompression.
- Findings support the value of prenatal counseling and treatment planning for MMC.
Abstract:
(1) Background: Fetal surgery for meningomyelocele (MMC) should reduce the occurrence of Arnold-Chiari malformations, hydrocephalus, the associated need for craniocervical decompression, and the need for cerebrospinal fluid shunt insertion. Fetal surgery should improve ambulatory status. (2) Methods: We used retrospective analysis of the documentation and descriptive statistics to summarize the clinical data and measured MRI parameters. The neurosurgical results are presented as the frequency of findings in percentages and compared with the results of the Management of Myelomeningocele Study (MOMS). (3) Results: A total of eight patients who underwent prenatal correction of MMC between 2016 and 2020 participated. MRI detected Chiari II malformation in all patients during prenatal imaging and in 87.5% of the patients at the age of 12 months. Craniocervical decompression was used in 25% of the patients. Shunt-dependent hydrocephalus occurred in 50% of the cases. In 87.5% of the cases, the functional level exceeded the expected ambulatory status. (4) Conclusions: We present the clinical status of our patients. Analysis of the complete cohort confirmed that prenatal surgery is associated with a reduced occurrence of Chiari malformations and reduced associated occurrence of hydrocephalus. Specific lesion levels are not associated with the need for craniocervical decompression. The results of our study are valuable in prenatal counseling and important for treatment planning.
