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Erschienen in:

12.01.2021 | Original Article

Fetal surgery for spina bifida in Zurich: results from 150 cases

verfasst von: Ueli Moehrlen, Nicole Ochsenbein, Ladina Vonzun, Luca Mazzone, Maya Horst, Sonja Schauer, David Alexander Wille, Cornelia Hagmann, Raimund Kottke, Patrice Grehten, Barbara Casanova, Nele Strübing, Theres Moehrlen, Sasha Tharakan, Beth Padden, Dirk Bassler, Roland Zimmermann, Martin Meuli

Erschienen in: Pediatric Surgery International | Ausgabe 3/2021

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Abstract

Purpose

Over the past 10 years, over 150 fetal spina bifida surgeries were performed at the Zurich Center for Fetal Diagnosis and Therapy. This study looks at surrogates for success and failure of this approach.

Methods

We focused on key outcome parameters including hydrocephalus shunt rate at one year, bladder control at 4, independent ambulation at 3 years, and maternal, fetal, and neonatal complications.

Results

From the first 150 patients undergoing fetal surgery for spina bifida, 148 (98.7%) were included in the study. Maternal–fetal surgery was uneventful in 143/148 (97%) cases. Intraoperative problems included resuscitation in 4/148 fetuses (2.7%). 1/148 fetuses (0.7%) died on postoperative day 4. Maternal complications included chorioamniotic membrane separation in 22/148 (15%), lung embolism in 3/148 (2.1%), chorioamnionitis in 2/148 (1.4%), AV-block III and uterine rupture in 1/148 each (0.7%). 1/148 (0.7%) newborn death was recorded. Hindbrain herniation was identified preoperatively in 132/148 (90%) fetuses and resolved completely in 119/132 (90%). At one year, 39/106 (37%) children had required a CSF diversion. At 4 years, 4/34 patients (12%) had normal bladder control. At 3 years, 48/57 (84%) walked independently.

Conclusion

A majority of patients benefitted from prenatal intervention, in that the shunt rate was lower and the rates of continent and walking patients were higher than reported with postnatal care.

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Titel: Fetal surgery for spina bifida in Zurich: results from 150 cases
verfasst von: Ueli Moehrlen
Nicole Ochsenbein
Ladina Vonzun
Luca Mazzone
Maya Horst
Sonja Schauer
David Alexander Wille
Cornelia Hagmann
Raimund Kottke
Patrice Grehten
Barbara Casanova
Nele Strübing
Theres Moehrlen
Sasha Tharakan
Beth Padden
Dirk Bassler
Roland Zimmermann
Martin Meuli
Publikationsdatum: 12.01.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 3/2021
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-020-04824-8

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Fetal surgery for spina bifida in Zurich: results from 150 cases