Corinna Keil, Benjamin Sass, Maximilian Schulze, Siegmund Köhler, Roland Axt-Fliedner, Ivonne Bedei
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In this review, we describe the different surgical procedures and their outcomes.</p><p><strong>Methods: </strong>This review is based on publications that were retrieved by a selective literature search in the MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane databases, employing pertinent keywords. Studies of all types (except case reports) that were published in English or German in the period 2010-2024 were included.</p><p><strong>Results: </strong>The randomized, controlled MOMS trial showed that intrauterine surgery for defect closure resulted in less progressive neural tissue damage than postnatal surgery and reduced the need for shunting by approximately half (40% vs. 82%). Since the publication of these results, various prenatal surgical procedures have been established, including hysterotomy-assisted, percutaneous fetoscopic, and laparotomy-assisted fetoscopic closure. The individual surgical methods yield comparable results in terms of motor function and shunt rate. A problem with these procedures is that they increase the likelihood of preterm birth, to an extent that varies from one type of procedure to another.</p><p><strong>Conclusion: </strong>Prenatal surgery improves motor function and reduces the shunt rate but long-term outcomes beyond adolescence are still lacking. 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引用次数: 0
摘要
背景:开放式脊柱畸形是一种先天性畸形,可导致严重的疾病。其后果包括感觉和运动障碍以及膀胱和肠功能障碍。它通常也与产前脑室肿大有关,这反过来又需要在大约80%的病例中进行脑室-腹膜分流术的产后治疗。产前治疗覆盖神经管缺损可降低分流率,保护运动功能。在这篇综述中,我们描述了不同的手术方法及其结果。方法:本综述基于在MEDLINE、Web of Science、EMBASE、Scopus和Cochrane数据库中选择性文献检索检索到的出版物,采用相关关键词。纳入了2010-2024年期间用英语或德语发表的所有类型的研究(病例报告除外)。结果:随机、对照的mom试验显示,宫内手术修复缺陷导致的进行性神经组织损伤比产后手术少,并减少了大约一半的分流需求(40%对82%)。自这些结果发表以来,已经建立了各种产前手术程序,包括子宫切开辅助,经皮胎儿镜和剖腹手术辅助胎儿镜闭合。不同的手术方法在运动功能和分流率方面产生了相似的结果。这些手术的一个问题是,它们增加了早产的可能性,其程度因手术类型而异。结论:产前手术改善了运动功能,降低了分流率,但青春期后的长期效果仍然缺乏。透明和跨学科的咨询在产前沟通中至关重要,不仅要告知父母这种治疗的潜在益处,还要告知其局限性和风险。
The Intrauterine Treatment of Open Spinal Dysraphism.
Background: Open spinal dysraphism is a congenital malformation that causes major morbidity. Its consequences include sensory and motor impairment as well as bladder- and bowel dysfunction. It is often also associated with prenatal ventriculomegaly, which, in turn, necessitates postnatal treatment with a ventriculoperitoneal shunt in approximately 80% of cases. Prenatal therapy with coverage of neural tube defect can reduce the shunt rate and preserve motor function. In this review, we describe the different surgical procedures and their outcomes.
Methods: This review is based on publications that were retrieved by a selective literature search in the MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane databases, employing pertinent keywords. Studies of all types (except case reports) that were published in English or German in the period 2010-2024 were included.
Results: The randomized, controlled MOMS trial showed that intrauterine surgery for defect closure resulted in less progressive neural tissue damage than postnatal surgery and reduced the need for shunting by approximately half (40% vs. 82%). Since the publication of these results, various prenatal surgical procedures have been established, including hysterotomy-assisted, percutaneous fetoscopic, and laparotomy-assisted fetoscopic closure. The individual surgical methods yield comparable results in terms of motor function and shunt rate. A problem with these procedures is that they increase the likelihood of preterm birth, to an extent that varies from one type of procedure to another.
Conclusion: Prenatal surgery improves motor function and reduces the shunt rate but long-term outcomes beyond adolescence are still lacking. Transparent and interdisciplinary counseling is essential in prenatal communication to inform parents not only about the potential benefits of this treatment, but also about its limitations and risks.
期刊介绍:
Deutsches Ärzteblatt International is a bilingual (German and English) weekly online journal that focuses on clinical medicine and public health. It serves as the official publication for both the German Medical Association and the National Association of Statutory Health Insurance Physicians. The journal is dedicated to publishing independent, peer-reviewed articles that cover a wide range of clinical medicine disciplines. It also features editorials and a dedicated section for scientific discussion, known as correspondence.
The journal aims to provide valuable medical information to its international readership and offers insights into the German medical landscape. Since its launch in January 2008, Deutsches Ärzteblatt International has been recognized and included in several prestigious databases, which helps to ensure its content is accessible and credible to the global medical community. These databases include:
Carelit
CINAHL (Cumulative Index to Nursing and Allied Health Literature)
Compendex
DOAJ (Directory of Open Access Journals)
EMBASE (Excerpta Medica database)
EMNursing
GEOBASE (Geoscience & Environmental Data)
HINARI (Health InterNetwork Access to Research Initiative)
Index Copernicus
Medline (MEDLARS Online)
Medpilot
PsycINFO (Psychological Information Database)
Science Citation Index Expanded
Scopus
By being indexed in these databases, Deutsches Ärzteblatt International's articles are made available to researchers, clinicians, and healthcare professionals worldwide, contributing to the global exchange of medical knowledge and research.