Spina bifida aperta

Minimalinvasive Operationsverfahren zur vorgeburtlichen Behandlung der Spina bifida haben in den vergangenen 10 Jahren so rasch an Verbreitung gewonnen, dass sie das über knapp 3 Jahrzehnte praktizierte, wesentlich invasivere, offene vorgeburtliche Operationsverfahren zunehmend verdrängen. Ziel dieses Beitrags ist es, interessierten Lesern einen Überblick über das Spektrum der Fehlbildung, ihre pränatale Diagnose und minimal-invasive Therapieoptionen zu geben.

Kernaussagen

• Die Fetalchirurgie bietet Spina-bifida-betroffenen Feten – bei geringer maternaler und kindlicher Morbidität – die Chance auf eine nachgeburtlich deutlich besser erhaltene Funktion der Gehfähigkeit sowie auf eine Besserung der begleitenden Gehirnveränderungen, der geistigen Entwicklung und somit der Lebensqualität.

• Auch die Funktionen von Blase, Enddarm und Schließmuskeln lassen sich vermutlich positiv beeinflussen. Aufgrund der Heterogenität der möglichen Inkontinenzproblematik sowie der in diesem Bereich uneinheitlichen nachgeburtlichen Diagnostik und therapeutischen Angebote sind diese Effekte schwieriger nachweisbar.

• Nach vorgeburtlicher Diagnose einer SBA müssen betroffene Schwangere heute auf die Möglichkeiten, Chancen und Risiken des vorgeburtlichen Operierens hingewiesen, und, wenn gewünscht, zur Beratung vorgestellt werden. Bei den weiterhin hohen Abbruchraten ist diese Information für betroffene Ungeborene von existenzieller Bedeutung.

Schlüsselwörter

Spina bifida aperta - SBA - Fetalchirurgie - minimal-invasive Chirurgie - Schwangerschaft - Fetus

Publication History

Article published online:
22 February 2024

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