Middle Cerebral Artery Doppler before and after Fetal Spina Bifida Repair: An Indirect Sign of Hindbrain Compression and Decompression?

IF 1.6 3区医学 Q3 OBSTETRICS & GYNECOLOGY Fetal Diagnosis and Therapy Pub Date : 2024-06-14 DOI:10.1159/000539773

Ladina Vonzun, Ladina Ruegg, Julia Zepf, Nele Strübing, Patrice Grehten, Martin Meuli, Luca Mazzone, Ueli Moehrlen, Nicole Ochsenbein-Koelble

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Abstract

Introduction: Reduced middle cerebral artery resistance indices (MCA-RI) in fetuses with spina bifida (fSB) are commonly observed. Compression of neuronal pathways in the brainstem due to hindbrain herniation (HH) and disturbed cerebrospinal fluid circulation likely cause an imbalance of the autonomic nervous system. This may increase systemic vasoconstriction and compensatory increase cerebral vasodilation (like brain sparing). The aim of this study was to systematically analyze all fetal MCA-RI before and after fSB repair and to compare their correlation with the presence and postsurgical resolution of HH.

Methods: 173 patients were included. Standardized ultrasound examinations including MCA and umbilical artery (UA) Doppler as well as assessment of HH presence and regression were performed. Fetuses with MCA-RI <5th percentile (P) before fetal surgery were compared to the group with normal MCA-RI and correlated to the presence of HH before and its regression after fSB repair.

Results: 30% (49/161) fetuses showed RI's <5th P before fSB repair. All fetuses had normal UA-RI. 99.4% of fetuses (160/161) showed normal of MCA-RI before delivery. Normalization occurred within a mean of 1.3 ± 1.2 weeks. HH regression was observed in 97% in the group with normal MCA-RI and in 96% in the group with MCA-RI <5th P before surgery (p = 0.59). Time lapse to HH regression after fSB repair was 1.8 ± 1.7 and 1.9 ± 1.6 weeks, respectively.

Conclusion: In fetuses with MCA-RIs <5 P before fSB repair, a parallel timely course of MCA-RI normalization and HH regression was noted. To suggest common pathogenic factor(s), more studies are needed. However, normalization of the fetal cerebral circulation could be a further benefit of fSB repair.

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胎儿脊柱裂修复前后的大脑中动脉多普勒：后脑受压和减压的间接标志？

导言：脊柱裂胎儿的大脑中动脉阻力指数（MCA-RI）降低是常见现象。后脑疝（HH）和脑脊液循环障碍导致脑干神经元通路受压，很可能造成自主神经系统失衡。这可能会增加全身血管收缩和代偿性增加脑血管扩张（如脑疏通）。本研究的目的是系统分析 fSB 修复前后的所有胎儿 MCA-RI，并比较其与 HH 存在和手术后缓解的相关性。方法：共纳入 173 例患者，进行了包括 MCA 和脐动脉（UA）多普勒在内的标准化超声检查，并评估了 HH 的存在和消退情况。将胎儿手术前MCA-RI<第5百分位数（P.）的胎儿与MCA-RI正常的胎儿组进行比较，并将两者与胎儿手术前是否存在HH及手术后HH是否消退进行比较：结果：30%（49/161）的胎儿在FSB修补术前显示出RI的第5百分位数。所有胎儿的 UA-RI 均正常。99.4%的胎儿（160/161）在分娩前显示 MCA-RI 正常。正常化平均发生在 1.3±1.2 周内。术前MCA-RI正常组中有97%的胎儿HH消退，MCA-RI<5thP.组中有96%的胎儿HH消退（P = 0.59）。FSB修复后HH消退的时间分别为1.8±1.7周和1.9±1.6周：结论：在fSB修复前MCA-RIs为5.P的胎儿中，MCA-RI正常化与HH消退的时间进程是平行的。要提出共同的致病因素，还需要更多的研究。然而，胎儿脑循环正常化可能是 fSB 修复的另一个益处。

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来源期刊

Fetal Diagnosis and Therapy 医学-妇产科学

CiteScore

4.70

自引率

9.10%

发文量

审稿时长

6-12 weeks

期刊介绍： The first journal to focus on the fetus as a patient, ''Fetal Diagnosis and Therapy'' provides a wide range of biomedical specialists with a single source of reports encompassing the common discipline of fetal medicine.