MRI analysis of neurodevelopmental anatomy in myelomeningocele: prenatal vs postnatal repair

• Published in: Ultrasound in obstetrics & gynecology 2024-09, Vol.64 (3), p.362-373
• Main Authors: Bruzek, A. K., Koller, G. M., Karuparti, S., Varagur, K., Dunbar, A., Flanders, T. M., Mingo, M., Sudanagunta, K., Bligard, K. H., Odibo, A., Vrecenak, J., Mian, A., Strahle, J. M.
• Format: Article
• Language: English
• Subjects: Anatomy; Brain; Brain architecture; brain development; Cerebrospinal fluid; Chiari‐II malformation; Fetuses; Gynecology; Hindbrain; hindbrain herniation; Human motion; Hydrocephalus; Magnetic resonance imaging; Medical imaging; Morphology; myelomeningocele; myelomeningocele‐related hydrocephalus; Neonates; Neuraxis; Neuroimaging; Obstetrics; Population studies; prenatal repair; Surgery; Ultrasonic imaging; Ultrasonic testing; Ultrasound
• ISSN: 0960-7692; 1469-0705; 1469-0705
• DOI: 10.1002/uog.27586

ABSTRACT Objective Compared with postnatal repair, prenatal myelomeningocele (MMC) repair is associated with improved motor function and decreased need for cerebrospinal fluid (CSF) diversion. It is unknown how prenatal surgery alters neuroanatomical structures identifiable on magnetic resonance imaging (MRI). The purpose of this study was to use MRI to compare neurodevelopmental anatomy in patients undergoing fetal MMC repair compared with those undergoing postnatal repair. Methods This was a retrospective review of neonates who underwent prenatal or postnatal MMC repair at our institution between 2016 and 2021. Imaging data, including prenatal ultrasound and pre‐ and postnatal MRI examinations, if available, were retrieved. We analyzed anatomical findings characteristically seen on MRI of the neuroaxis in patients with MMC and compared imaging findings between patients with prenatal vs postnatal MMC repair. Results The study population included 61 patients who underwent surgical repair for MMC during the 6‐year study period, of whom 25 underwent prenatal repair and 36 postnatal repair. CSF diversion was required in 24% of the prenatally repaired cohort vs 67% of the postnatally repaired cohort (P = 0.001). On postnatal MRI, a syrinx was present in 13% of the prenatally repaired cohort vs 42% in the postnatally repaired cohort (P = 0.02). Postnatal corpus callosal (CC) morphology was abnormal in 54% of the prenatally repaired cohort vs 53% of the postnatally repaired cohort (P = 0.92), while falx morphology was normal in 92% of the prenatally repaired cohort vs 34% of the postnatally repaired cohort (P