(1163) Rate of tethered spinal cord release after fetoscopic repair of open spina bifida

Objective: A recent meta-analysis reported approximately 22% rate of symptomatic tethered spinal cord (TSC) at 4.1 years median age of follow-up after prenatal closure of open spina bifida (OSB). TSC was defined as either neurologic deterioration, urological deterioration, or need for a surgical TSC release. The aim of this study was to assess the rate of surgical TSC release in a cohort of patients who underwent fetoscopic repair of OSB, followed between 2.5 and 5 years of life.

Study Design:

This was a prospective study of patients who underwent percutaneous or percutaneous mini-laparotomy fetoscopic OSB repair between 24 and 28 gestational weeks and who were followed for 2.5 to 5 years of life. The postnatal evaluation and treatment were at the discretion of the referring team and based on clinical findings and symptoms.

 

Results: Of 105 consecutive patients who received the fetoscopic OSB repair and achieved 30 months of age, 6 (5.7%) underwent a surgical TSC release procedure. Table 1 shows specific details of these 6 cases. Four of these 6 patients developed symptomatic hydrocephalus and were treated with a shunt or endoscopic third ventriculostomy, two at the same time of the TSC release. Because of the small number of affected patients, risk factors for receiving a detethering procedure could not be assessed.

Conclusion:

Of patients who underwent fetoscopic OSB repair and were between 2.5 to 5 years of age, 5.7% underwent a surgical TSC release procedure. As TSC symptomology may not arise until the later childhood or adolescent period, further long term follow up is necessary. Understanding the risk factors for development of symptomatic TSC will be important to optimize the prenatal surgical approach.