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

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.

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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