Related Experiment Video
Updated: May 18, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Ventricle Width and Cerebrospinal Fluid Diversion Rate after Open Fetal Spina Bifida Repair: A 4-Year Follow-Up
Julia Wawrla-Zepf1,2, Ladina Rüegg3,4, Martin Meuli4
1Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland, julia.zepf@usz.ch.
Insights
Postnatal cerebrospinal fluid diversion (CSFD) is needed in 35% of infants after open fetal spina bifida repair. Larger prenatal ventricular size, not head circumference, predicts the need for CSFD.
Area of Science:
- Neuroscience
- Pediatric Surgery
- Neonatology
Background:
- Open fetal spina bifida (fSB) repair is a complex procedure with potential postnatal complications.
- Cerebrospinal fluid diversion (CSFD) is often required to manage hydrocephalus following fSB repair.
- Understanding prenatal risk factors (RF) for CSFD is crucial for optimizing patient management.
Purpose of the Study:
- To determine the rate of postnatal CSFD after open fSB repair.
- To identify prenatal risk factors associated with the need for CSFD.
- To analyze the incremental risk (IR) of CSFD over a 4-year follow-up period.
Main Methods:
- A cohort of 185 patients undergoing open fSB repair was studied.
- CSFD rates were assessed at 1, 2, and 4 years postnatally.
- Prenatal and screening measurements of head circumference (HC) and ventricular size (Vp) were analyzed using multiple regression to identify RF for CSFD.
Main Results:
- The 1-year CSFD rate was 35% (64 children).
- Larger ventricular size at screening (Vp-screening) and before delivery (Vp-delivery), and their difference, were independent RF for CSFD.
- Head circumference was not found to be an independent RF; however, ventricular size correlated with earlier CSFD within the first year.
Conclusions:
- The incidence of CSFD within the first year after open fSB repair is significant (35%).
- Prenatal ventricular size is a key predictor of postnatal CSFD, influencing the timing of intervention.
- The incremental risk of CSFD decreases over the first four years post-repair, suggesting stabilization in some patients.
Introduction:
The objective of this study was to assess the postnatal cerebrospinal fluid diversion (CSFD) rates and associated prenatal risk factors (RFs) in patients with open fetal spina bifida (fSB) repair over a 4-year follow-up.
Methods:
In 185 patients, CSFD rate was determined at 1 year and incremental risk (IR) for CSFD at 2 and 4 years. Characteristics of children without CSFD were compared to those with CSFD, and multiple regression analysis evaluated RF.
Results:
Sixty-four children (35%) needed CSFD within the first year. These children had larger head circumference (HC) at screening (p = 0.001) and before delivery (p < 0.001) and larger ventricles at screening (Vp screening) and before delivery (Vp delivery) (each p < 0.001). Multiple regression identified only Vp screening, Vp delivery, and their delta as independent RF for CSFD. Vp values were higher in children needing CSFD within the first year compared with years 2-4 (p < 0.001 and p = 0.01), and larger Vp was associated with earlier CSFD in the first year (p = 0.02). IR for CSFD declined over follow-up.
Conclusion:
The 1-year CSFD rate after open fSB repair was 35%, with decreasing IR through year four. Larger Vp at screening, before delivery, and their delta were independent RF for CSFD, while HC was not.
