Long-Term Imaging Follow-up from the Management of Myelomeningocele Study - PubMed (original) (raw)

Long-Term Imaging Follow-up from the Management of Myelomeningocele Study

E George et al. AJNR Am J Neuroradiol. 2023 Jul.

Abstract

Background and purpose: Short-term results demonstrate that prenatal repair of a myelomeningocele is associated with a reduction in hydrocephalus and an increased likelihood of the reversal of Chiari II malformations compared with postnatal repair. The purpose of this study was to identify the long-term imaging findings at school age among subjects who underwent pre- versus postnatal repair of a myelomeningocele.

Materials and methods: A subset of subjects enrolled in the Management of Myelomeningocele Study who underwent either prenatal (n = 66) or postnatal (n = 63) repair of a lumbosacral myelomeningocele and had follow-up brain MR imaging at school age were included. The prevalence of posterior fossa features of Chiari II malformation and supratentorial abnormalities and the change in these findings from fetal to school-age MR imaging were compared between the 2 groups.

Results: Prenatal repair of a myelomeningocele was associated with higher rates of normal location of fourth ventricle and lower rates of hindbrain herniation, cerebellar herniation, tectal beaking, brainstem distortion, and kinking at school age compared with postnatal repair (all P < .01). Supratentorial abnormalities, including corpus callosal abnormalities, gyral abnormalities, heterotopia, and hemorrhage, were not significantly different between the 2 groups (all _P_ > .05). The rates of resolution of brainstem kinking, tectal beaking, cerebellar and hindbrain herniation, and normalization of fourth ventricle size from fetal to school age MR imaging were higher among the prenatal compared with postnatal surgery group (all, P < .02).

Conclusions: Prenatal repair of a myelomeningocele is associated with persistent improvement in posterior fossa imaging findings of Chiari II malformation at school age compared with postnatal repair.

© 2023 by American Journal of Neuroradiology.

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Figures

FIGURE.

FIGURE.

A and B, A 25-week-old fetus with a lumbosacral MMC (arrow) and Chiari II malformation (arrow) with the cerebellum extending to approximately the C3 level. The patient underwent postnatal repair with follow-up MR imaging (C) at 8 years demonstrating persistent brainstem and cerebellar herniation to C2 (white arrow). D, A 21-week 6-day-old fetus with a lower lumbar MMC (arrow) and Chiari II malformation with the cerebellum extending to approximately the C3 level (arrow). E, Status post fetal repair at 22 weeks 5 days with no residual cerebellar or brainstem herniation at 9 years of age (white arrow).

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