Fetoscopic repair of open spina bifida between 26 0/7 and 27 6/7 gestational weeks and postnatal cerebrospinal fluid...

Area of Science:

• Medical research
• Fetal surgery
• Pediatric neurosurgery

Background:

• The traditional gestational age cutoff for prenatal open spina bifida repair is 25 6/7 weeks.
• Limited data exist on outcomes for prenatal repair performed after 25 weeks.
• Approximately 40% of infants undergoing prenatal open spina bifida repair require cerebrospinal fluid diversion within the first year of life.

Purpose of the Study:

• To evaluate the rate and risk factors for cerebrospinal fluid diversion in fetuses undergoing open spina bifida repair between 26 0/7 and 27 6/7 gestational weeks.
• To compare outcomes with the traditional cutoff of 25 6/7 weeks.

Main Methods:

• A descriptive study of patients who underwent fetoscopic open spina bifida repair between 26 0/7 and 27 6/7 gestational weeks (2019-2023).
• Prospective data collection focusing on predictors of cerebrospinal fluid diversion within the first 12 months of life.
• Statistical analysis including bivariate and multiple logistic regression.

Main Results:

• Of 42 patients, 12 (28.6%) required cerebrospinal fluid diversion.
• Preoperative ventricular size was significantly associated with the need for diversion (p = .015).
• Ventriculomegaly ≥15 mm was linked to a higher likelihood of diversion (OR 5.23, p = .054).

Conclusions:

• Prenatal open spina bifida repair between 26 0/7 and 27 6/7 gestational weeks is associated with a 28.6% risk of postnatal cerebrospinal fluid diversion by 12 months.
• These results are comparable to those reported for repairs performed at or before 25 6/7 weeks.
• The findings suggest that extending the gestational window for prenatal repair may be feasible without increasing the risk of cerebrospinal fluid diversion.