Fetoscopic repair of open spina bifida between 26 0/7 and 27 6/7 gestational weeks and postnatal cerebrospinal fluid diversion

Abstract

Objective: To assess the rate and risk factors for cerebrospinal fluid (CSF) diversion among cases of prenatal repair of open spina bifida (OSB) performed from 26 0/7 to 27 6/7 gestational weeks, given a traditional cutoff of 25 6/7 weeks. Methods: This is a descriptive study of patients who underwent fetoscopic OSB repair (2019-2023) from 26 0/7 to 27 6/7 gestational weeks. Data were collected prospectively and examined as predictors of CSF diversion (ventriculoperitoneal shunt or endoscopic third ventriculostomy) within the first 12 months of life. Results: Of 42 study patients, CSF diversion was required in 12 cases (28.6%). In bivariate analysis, only preoperative ventricular size was associated with the CSF diversion procedure (largest ventricle 14.5 ± 3.0 vs 11.9 ± 2.5 mm, p =.015). Multiple logistic regression showed that cases with preoperative ventriculomegaly ≥15 mm appeared more likely to have CSF diversion (OR 5.23, 95% CI 0.98–28.09, p =.054). Neither level of the lesion nor myeloschisis was associated with CSF diversion. Conclusion: Prenatal OSB repair from 26 0/7 to 27 6/7 gestational weeks was associated with a 28.6% risk of postnatal CSF diversion at 12 months of life. Results are similar to those in which repair is performed ≤25 6/7 weeks. What’s already known about this topic?: Approximately 40% of patients undergoing prenatal open spina bifida (OSB) repair need CSF diversion at 1 year of life. The upper limit for percutaneous fetoscopic OSB repair has been 25 6/7 gestational weeks; few data exist regarding outcomes of prenatal repair after 25 weeks. What does this study add?: OSB repair at 26 0/7–27 6/7 gestational weeks appeared to provide a similar benefit in reducing CSF diversion risk at 1 year of life.