Prenatal Sonographic Head Circumference and Cerebral Ventricle Width Measurements Before and After Open Fetal Myelomeningocele Repair – Prediction of Shunting During the First Year of Life

Abstract

Purpose The aim of this study was to describe the sonographic evolution of fetal head circumference (HC) and width of the posterior horn of the lateral ventricle (Vp) after open fetal myelomeningocele (fMMC) repair and to assess whether pre- or postoperative measurements are helpful to predict the need for shunting during the first year of life.

Patients & Methods All 30 children older than one year by January 2017 who previously had fMMC repair at the Zurich Center for Fetal Diagnosis and Therapy were included. Sonographic evolution of fetal HC and Vp before and after fMMC repair was assessed and compared between the non-shunted (N = 16) and the shunted group (N = 14). ROC curves were generated for the fetal HC Z-score and Vp in order to show their predictive accuracy for the need for shunting until 1 year of age.

Results HC was not an independent factor for predicting shunting. However, the need for shunting was directly dependent on the preoperative Vp as well as the Vp before delivery. A Vp > 10 mm at evaluation for fMMC repair or > 15 mm before delivery identifies 100 % of the infants needing shunt placement at a false-positive rate of 44 % and 25 %, respectively. All fetuses with a Vp > 15 mm at first evaluation received a shunt.

Conclusion Fetuses demonstrating a Vp of > 15 mm before in utero MMC repair are extremely likely to develop hydrocephalus requiring a shunt during the first year of life. This compelling piece of evidence must be appropriately integrated into prenatal counseling.

Zusammenfassung

Ziel Die Ziele dieser Studie waren, die sonografische Entwicklung des fetalen Kopfumfangs (KU) sowie der lateralen Ventrikel-Weiten (VW) nach offener fetaler Myelomeningocelen (fMMC) -Operation zu beschreiben sowie herauszufinden, ob diese prä- und/oder postoperativen Messungen zur Vorhersage der Shunt-Bedürftigkeit im ersten Lebensjahr verwendet werden können.

Patienten und Methode Alle 30 der am Zürich Zentrum für fetale Diagnostik und Therapie operierten Kinder, welche im Januar 2017 ≥ 1-jährig waren, wurden in die Studie eingeschlossen. Die sonografische Entwicklung der KU und VW vor und nach MMC-Operation wurde retrospektiv analysiert und zwischen der nicht geshunteten (N = 16) und geshunteten (N = 14) Gruppe verglichen. Um die Shunt-Bedürftigkeit im ersten Lebensjahr vorherzusagen, wurden ROC-Kurven für die KU-Z-Scores und VW generiert.

Ergebnisse Der Kopfumfang war kein unabhängiger Faktor zur Vorhersage der Shunt-Bedürftigkeit. Die Notwendigkeit einer Shunt-Einlage war hingegen direkt von der prä- und postoperativen VW abhängig. Eine präoperative VW > 10 mm oder > 15 mm vor Entbindung identifizierte 100 % der Shunt-bedürftigen Kinder bei einer fasch-positiv-Rate von 44 % respektive 25 %. Alle Feten mit einer VW > 15 mm vor fMMC-Operation wurden Shunt-bedürftig.

Schlussfolgerung Föten mit präoperativen VW von > 15 mm entwickeln während des ersten Lebensjahres praktisch immer einen Shunt-pflichtigen Hydrozephalus. Diese Erkenntnis muss in die pränatale Beratung einfließen.

Key words

fetal myelomeningocele repair - spina bifida - ventriculoperitoneal shunting - fetal head circumference - ventriculomegaly

Publikationsverlauf

Eingereicht: 11. Juni 2018

Angenommen: 24. September 2018

Artikel online veröffentlicht:
22. Oktober 2018

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