RESUMO
PURPOSE: The aim of this study was to describe the sonographic evolution of fetal head circumference (HC) and width of the posterior horn of the lateral ventricle (Vp) after open fetal myelomeningocele (fMMC) repair and to assess whether pre- or postoperative measurements are helpful to predict the need for shunting during the first year of life. PATIENTS & METHODS: All 30 children older than one year by January 2017 who previously had fMMC repair at the Zurich Center for Fetal Diagnosis and Therapy were included. Sonographic evolution of fetal HC and Vp before and after fMMC repair was assessed and compared between the non-shunted (Nâ=â16) and the shunted group (Nâ=â14). ROC curves were generated for the fetal HC Z-score and Vp in order to show their predictive accuracy for the need for shunting until 1 year of age. RESULTS: HC was not an independent factor for predicting shunting. However, the need for shunting was directly dependent on the preoperative Vp as well as the Vp before delivery. A Vpâ>â10âmm at evaluation for fMMC repair or >â15âmm before delivery identifies 100â% of the infants needing shunt placement at a false-positive rate of 44â% and 25â%, respectively. All fetuses with a Vpâ>â15âmm at first evaluation received a shunt. CONCLUSION: Fetuses demonstrating a Vp of >â15âmm before in utero MMC repair are extremely likely to develop hydrocephalus requiring a shunt during the first year of life. This compelling piece of evidence must be appropriately integrated into prenatal counseling.