PDF(Pubmed)
Abstract：
OBJECTIVE: To report the need for cord untethering after prenatal repair of open spina bifida using a unique biocellulose-based technique performed at a later gestational age.
METHODS: An observational cohort study was conducted to determine the incidence of tethered cord syndrome. Between May 2013 and May 2022, we performed 172 procedures using the percutaneous fetoscopic approach in fetuses at 26-28 weeks of gestation. After placode dissection, a biocellulose patch was placed to cover the placode, a myofascial flap (when possible) was dissected, and the skin was closed. Owing to death or loss to follow-up, 23 cases were excluded. Cord tethering syndrome was defined as symptoms of medullary stretching, and the infants were evaluated and operated on by local neurosurgeons after an magnetic resonance imaging examination. Infants over 30-month had ambulation and neurodevelopment evaluations (PEDI scale).
RESULTS: Among 172 cases operated at a median gestational age of 26.7 weeks and delivered at 33.2 weeks, 149 cases were available for postnatal follow-up, and cord untethering was needed in 4.4% of cases (6/136; excluding 13 cases younger than 12 months). Cerebrospinal fluid diversion and bladder catheterization were needed in 38% and 36% of cases, respectively. Of the 78 cases evaluated at 30 months, 49% were ambulating independently, and 94% had normal social function.
CONCLUSIONS: The biocellulose-based technique was associated with a low rate of cord tethering, wich may be attributed to the lack of the duramater suture during prenatal repair, the formation of a neoduramater and/or later gestational age of surgery.
METHODS: An observational cohort study was conducted to determine the incidence of tethered cord syndrome. Between May 2013 and May 2022, we performed 172 procedures using the percutaneous fetoscopic approach in fetuses at 26-28 weeks of gestation. After placode dissection, a biocellulose patch was placed to cover the placode, a myofascial flap (when possible) was dissected, and the skin was closed. Owing to death or loss to follow-up, 23 cases were excluded. Cord tethering syndrome was defined as symptoms of medullary stretching, and the infants were evaluated and operated on by local neurosurgeons after an magnetic resonance imaging examination. Infants over 30-month had ambulation and neurodevelopment evaluations (PEDI scale).
RESULTS: Among 172 cases operated at a median gestational age of 26.7 weeks and delivered at 33.2 weeks, 149 cases were available for postnatal follow-up, and cord untethering was needed in 4.4% of cases (6/136; excluding 13 cases younger than 12 months). Cerebrospinal fluid diversion and bladder catheterization were needed in 38% and 36% of cases, respectively. Of the 78 cases evaluated at 30 months, 49% were ambulating independently, and 94% had normal social function.
CONCLUSIONS: The biocellulose-based technique was associated with a low rate of cord tethering, wich may be attributed to the lack of the duramater suture during prenatal repair, the formation of a neoduramater and/or later gestational age of surgery.
摘要：
目的：报告使用一种独特的基于生物纤维素的技术对开放性脊柱裂进行产前修复后脐带松脱的必要性。
方法：进行了一项观察性队列研究，以确定脊髓栓系综合征的发生率。在2013年5月至2022年5月之间，我们在妊娠26-28周的胎儿中使用经皮胎儿镜方法进行了172例手术。在placode解剖之后,放置生物纤维素贴片来覆盖placode，解剖了肌筋膜瓣（如果可能），皮肤闭合。由于死亡或失去随访，排除23例。脊髓栓系综合征被定义为延髓伸展的症状，在磁共振成像检查后，由当地神经外科医生对婴儿进行评估和手术。超过30个月的婴儿进行了步行和神经发育评估（PEDI量表）。
结果：在172例中位胎龄为26.7周，分娩时间为33.2周的病例中，149例可以进行产后随访，4.4%的病例(6/136;不包括13例年龄小于12个月的病例)需要解开脐带。38％和36％的病例需要脑脊液改道和膀胱导管插入术，分别。在30个月时评估的78例病例中，49%的人独立行走，94%的人有正常的社会功能。
结论：基于生物纤维素的技术与脐带系链的低比率有关，这可能是由于在产前修复过程中缺乏硬膜缝合，新uramater的形成和/或手术的胎龄较晚。
方法：进行了一项观察性队列研究，以确定脊髓栓系综合征的发生率。在2013年5月至2022年5月之间，我们在妊娠26-28周的胎儿中使用经皮胎儿镜方法进行了172例手术。在placode解剖之后,放置生物纤维素贴片来覆盖placode，解剖了肌筋膜瓣（如果可能），皮肤闭合。由于死亡或失去随访，排除23例。脊髓栓系综合征被定义为延髓伸展的症状，在磁共振成像检查后，由当地神经外科医生对婴儿进行评估和手术。超过30个月的婴儿进行了步行和神经发育评估（PEDI量表）。
结果：在172例中位胎龄为26.7周，分娩时间为33.2周的病例中，149例可以进行产后随访，4.4%的病例(6/136;不包括13例年龄小于12个月的病例)需要解开脐带。38％和36％的病例需要脑脊液改道和膀胱导管插入术，分别。在30个月时评估的78例病例中，49%的人独立行走，94%的人有正常的社会功能。
结论：基于生物纤维素的技术与脐带系链的低比率有关，这可能是由于在产前修复过程中缺乏硬膜缝合，新uramater的形成和/或手术的胎龄较晚。
