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

Pediatric Surgery International volume 37, pages 311–316 (2021)Cite this article

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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Acknowledgements

We thank the Clinical Trial Center, University Hospital Zurich, for hosting the Redcap® Database; we thank the following Foundations for their generous financial support for this study: Zwillenberg Foundation, Berne, Switzerland and Uniscientia, Zurich, Switzerland.

Author information

Author notes

  1. Roland Zimmermann and Martin Meuli Shared last authorship.

Authors and Affiliations

  1. Department of Pediatric Surgery, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Ueli Moehrlen, Luca Mazzone, Maya Horst, Sonja Schauer, Barbara Casanova, Theres Moehrlen, Sasha Tharakan & Martin Meuli

  2. The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland

    Ueli Moehrlen, Nicole Ochsenbein, Ladina Vonzun, Luca Mazzone, Barbara Casanova, Nele Strübing, Theres Moehrlen, Sasha Tharakan, Roland Zimmermann & Martin Meuli

  3. Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland

    Nicole Ochsenbein, Ladina Vonzun, Nele Strübing & Roland Zimmermann

  4. Department of Neonatology, University Hospital Zurich, Zurich, Switzerland

    Dirk Bassler

  5. Division of Pediatric Neurology, University Children’s Hospital Zurich, Zurich, Switzerland

    David Alexander Wille

  6. Division of Pediatric Rehabilitation, University Children’s Hospital Zurich, Zurich, Switzerland

    Beth Padden

  7. Division of Diagnostic Imaging, MR-Center, University Children’s Hospital Zurich, Zurich, Switzerland

    Raimund Kottke & Patrice Grehten

  8. Division of Intensive Care and Neonatology, University Children’ Hospital Zurich, Zurich, Switzerland

    Cornelia Hagmann

  9. Zurich Center for Spina Bifida, University Children’s Hospital Zurich, Zurich, Switzerland

    Luca Mazzone, Maya Horst, Sonja Schauer, David Alexander Wille & Beth Padden

  10. Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, Zurich, Switzerland

    Ueli Moehrlen, Luca Mazzone, Maya Horst, Sonja Schauer, David Alexander Wille, Cornelia Hagmann, Raimund Kottke, Patrice Grehten, Barbara Casanova, Theres Moehrlen, Sasha Tharakan, Beth Padden & Martin Meuli

  11. University of Zurich, Zurich, Switzerland

    Ueli Moehrlen, Nicole Ochsenbein, Dirk Bassler, Roland Zimmermann & Martin Meuli

Authors
  1. Ueli Moehrlen
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  2. Nicole Ochsenbein
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Correspondence to Ueli Moehrlen.

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Moehrlen, U., Ochsenbein, N., Vonzun, L. et al. Fetal surgery for spina bifida in Zurich: results from 150 cases. Pediatr Surg Int 37, 311–316 (2021). https://doi.org/10.1007/s00383-020-04824-8

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  • DOI: https://doi.org/10.1007/s00383-020-04824-8

Keywords

  • Spina bifida
  • Myelomeningocele
  • Myeloschisis
  • Fetal surgery
  • In utero surgery
  • Outcome