Craniospinal MRI findings in spina bifida patients following fetoscopic, open and postnatal repair

Abstract

BACKGROUND: Prenatal spina bifida repair and its clinical outcome are increasingly seen as topics of research even though early postnatal repair is routinely recommended for the treatment of spina bifida. The aim of this study was to evaluate the cranio-spinal MRI findings in spina bifida patients following prenatal and postnatal repair in a five-year follow-up study. METHODS: Hydrocephalus, Chiari malformation, malformations of cortical development, vertebral anomalies, syringohydromyelia, diastematomyelia, tethered cord were the parameters investigated in the cranio-spinal MRI of a group of nine patients that underwent prenatal (fetoscopic/open) or postnatal repair for spinal dysraphism. RESULTS: Follow-up MRI revealed no sign of Chiari malformation in patients that underwent prenatal repair. Hydrocephalus, gyral interdigitation and Chiari malformation were observed in the MRI of all of three patients that underwent postnatal repair. Heterotopia, polymicrogyria, and vermian hypoplasia were determined only in patients from postnatal repair group. In the fetoscopic repair group, scoliosis was seen in all patients, while vertebral segmentation, fusion anomalies, sacral dysgenesis were absent. In the prenatal open repair group vertebral segmentation was seen in one patient, scoliosis in two patients, while fusion anomalies and sacral dysgenesis were absent. Tethered cord syndrome was identified in all patients that underwent prenatal open repair and postnatal repair. CONCLUSIONS: In this category of patients larger and homogenous study groups combined with long term follow-up periods including evaluation of the cranial and spinal MRIs are necessary in order to have a better perspective over the consequences of each of these neurosurgical techniques.