Risk factors for shunting at 12 months following open fetal repair of spina bifida by mini-hysterotomy
Author:
Neves da Rocha Luana Sarmento1ORCID, Bunduki Victor1, Cardeal Daniel Dante2, de Amorim Filho Antônio Gomes3ORCID, Nani Fernando Souza4, Peres Stela Verzinhasse1, de Carvalho Werther Brunow5, de Francisco Rossana Pulcineli Vieira1, de Carvalho Mário Henrique Burlacchini1
Affiliation:
1. Obstetrics , Department of Obstetrics and Ginecology , FMUSP School of Medicine , São Paulo University , São Paulo , Brazil 2. Neurosurgery , Department of Neurology/Neurosurgery , FMUSP School of Medicine , São Paulo University , São Paulo , Brazil 3. Obstetrics Clinic Division , Hospital das Clínicas HCFMUSP , School of Medicine , São Paulo University , São Paulo , Brazil 4. Anesthesiology , Department of Anesthesiology/Sugery , FMUSP School of Medicine , São Paulo University , São Paulo , Brazil 5. Neonatology Division , Child Institute at Hospital das Clínicas HCFMUSP , FMUSP School of Medicine , São Paulo University , São Paulo , Brazil
Abstract
Abstract
Objectives
Open spina bifida (OSB) is the most common neural tube defect. Prenatal repair reduces the need for ventriculoperitoneal shunting (VPS) due to hydrocephalus from 80–90% to 40–50%. We aimed to determine which variables work as risk factors for VPS at 12 months of age in our population.
Methods
Thirty-nine patients underwent prenatal repair of OSB by mini-hysterotomy. The main outcome was occurrence of VPS in the first 12 months of life. Logistic regression was used to estimate the odds ratios (OR) between prenatal variables and the need for shunting.
Results
VPS at 12 months occurred in 34.2% of the children. Larger ventricle size before surgery (62.5% ≥15 mm; 46.2% between 12 and 15 mm; 11.8% <12 mm; p=0.008), higher lesion level (80% >L2, vs. 17.9% ≤L3; p=0.002; OR, 18.4 [2.96–114.30]), and later gestational age at surgery (25.25 ± 1.18 vs. 24.37 ± 1.06 weeks; p=0.036; OR, 2.23 [1.05–4.74]) were related to increased need for shunting. In the multivariate analysis, larger ventricle size before surgery (≥15 mm vs. <12 mm; p=0.046; OR, 1.35 [1.01–1.82]) and higher lesion level (>L2 vs. ≤L3; p=0.004; OR, 39.52 [3.25–480.69]) were risk factors for shunting.
Conclusions
Larger ventricle size before surgery (≥15 mm) and higher lesion level (>L2) are independent risk factors for VPS at 12 months of age in fetuses undergoing prenatal repair of OSB by mini-hysterotomy in the studied population.
Publisher
Walter de Gruyter GmbH
Subject
Obstetrics and Gynecology,Pediatrics, Perinatology and Child Health
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