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Purpose <p>To evaluate the association between lesion volume and postnatal outcomes in patients with closed spina bifida (SB).</p> Methods <p>Single-center retrospective review of all patients diagnosed with a closed SB evaluated between 2013 and 2023. Prenatal lesion volume &lt; 3&#xa0;mL was categorized as “no sac,” and volume ≥ 3&#xa0;mL was categorized as “sac.”</p> Results <p>Of eligible patients, 22 had a sac, and 33 did not. Myelocystocele patients more commonly had an associated saccular lesion than lipomyelomeningoceles (80% vs. 28%, <i>p</i> = 0.02). Lipomyelomeningocele patients demonstrated less prenatal lesion growth compared to myelocystocele patients (6.26 vs. 58.0&#xa0;mL) over a median of 12.7 and 10.5&#xa0;weeks, respectively. Patients with a sac had a higher proportion of talipes (40.9% vs. 9.1%; <i>p</i> = 0.007) compared to those without. At 5&#xa0;years old, a higher proportion of patients with no sac was able to ambulate independently and required less CIC than patients with a sac (80% vs. 42%; 0% vs. 41.7%). VUDS showed a greater frequency of detrusor overactivity (60.0% vs. 45.0%) and abnormal bladder compliance (60.0% vs. 5.0%) in those with a sac compared to those without. Repeat tethered cord release was also more common (30.0% vs. 3.4%) among patients with a sac-associated defect.</p> Conclusions <p>Patients with a sac had an increased risk of prenatal talipes, decreased ability to ambulate independently, increased use of CIC, and increased need for repeat tethered cord release compared to patients without a sac. Given numerous associated morbidities reported in this study, longitudinal multidisciplinary follow-up is critical in the care of these patients.</p>

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Clinical impact of fetal sac size on closed neural tube defects

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年7月9日

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  • Sierra D. Land,
  • Taryn Gallagher,
  • Sanjana R. Salwi,
  • Tom A. Reynolds,
  • Leny Mathew,
  • Edward R. Oliver,
  • Dana A. Weiss,
  • Tracy M. Flanders,
  • Juliana S. Gebb,
  • N. Scott Adzick,
  • Gregory G. Heuer

摘要

Purpose

To evaluate the association between lesion volume and postnatal outcomes in patients with closed spina bifida (SB).

Methods

Single-center retrospective review of all patients diagnosed with a closed SB evaluated between 2013 and 2023. Prenatal lesion volume < 3 mL was categorized as “no sac,” and volume ≥ 3 mL was categorized as “sac.”

Results

Of eligible patients, 22 had a sac, and 33 did not. Myelocystocele patients more commonly had an associated saccular lesion than lipomyelomeningoceles (80% vs. 28%, p = 0.02). Lipomyelomeningocele patients demonstrated less prenatal lesion growth compared to myelocystocele patients (6.26 vs. 58.0 mL) over a median of 12.7 and 10.5 weeks, respectively. Patients with a sac had a higher proportion of talipes (40.9% vs. 9.1%; p = 0.007) compared to those without. At 5 years old, a higher proportion of patients with no sac was able to ambulate independently and required less CIC than patients with a sac (80% vs. 42%; 0% vs. 41.7%). VUDS showed a greater frequency of detrusor overactivity (60.0% vs. 45.0%) and abnormal bladder compliance (60.0% vs. 5.0%) in those with a sac compared to those without. Repeat tethered cord release was also more common (30.0% vs. 3.4%) among patients with a sac-associated defect.

Conclusions

Patients with a sac had an increased risk of prenatal talipes, decreased ability to ambulate independently, increased use of CIC, and increased need for repeat tethered cord release compared to patients without a sac. Given numerous associated morbidities reported in this study, longitudinal multidisciplinary follow-up is critical in the care of these patients.