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Impact of maternal fetal surgery for myelomeningocele on the progression of ventriculomegaly in utero

      Objective

      Maternal-fetal surgery (MFS) for myelomeningocele (MMC) has been reported to decrease hindbrain herniation and the need for postnatal ventriculoperitoneal shunt. This study examines the impact of MFS on the progression of ventriculomegaly in utero.

      Study design

      Medical records for all cases of fetal MMC diagnosed at UNC from 6/1988 to 4/2003, were reviewed. The relationship between the repeated measurements of the lateral ventricle with advancing gestational age (GA) and MFS was evaluated with generalized estimating equations for a multivariate linear regression model that included baseline ventricle measurement, GA, GA at baseline, level of spinal cord lesion, and gender, as well as linear and quadratic GA during follow-up for pre- or postnatal surgical repair.

      Results

      52 of 79 prenatally diagnosed cases of MMC had records available. 13 (25%) had in utero and 39 (75%) had postnatal repair. Atrial size was larger for male fetuses, with no difference in rate of progression by gender. There was a nonsignificant trend toward larger ventricle measurements with a higher level of lesion. MFS did not transiently or permanently impact the progression of ventriculomegaly in utero. The overall rate of progression for both groups was 0.43 mm/week.

      Conclusion

      After controlling for baseline degree of ventriculomegaly and level of spinal cord lesion, MFS does not appear to transiently or permanently impact the progression of ventriculomegaly in utero. Other CNS dynamics may explain the reported decrease in need for postnatal ventriculoperitoneal shunts following MFS.
      §
      VariableEstimateStandard ErrorType III P value
      Gender (Female vs Male)−2.31350.95360.0271
      Significant at the alpha=0.05 level.
      Lesion (Lumbosacral vs Thoracic)−3.27143.97470.1071
      Lesion (Sacral vs Thoracic)−6.47434.08740.1071
      GA-Baseline−0.30580.20950.1501
      Ventricle Measurement-Baseline0.90510.15460.0053
      Significant at the alpha=0.05 level.
      Repair (Postnatal vs Prenatal)0.12851.11690.9083
      GA0.42540.17940.0090
      Significant at the alpha=0.05 level.
      § Significant at the alpha=0.05 level.