Fetal head biometry following in-utero repair of myelomeningocele.
OBJECTIVE
To evaluate the impact of prenatal myelomeningocele repair on fetal head biometry.


METHODS
Fifty fetuses underwent open fetal myelomeningocele repair at our institution between January 1998 and July 2002. All had serial head circumference (HC) and lateral ventricular diameter (VD) measurements taken preoperatively and weekly for 8 weeks after repair. Cortical index (CI) was defined as HC/VD. Measurements were compared with gestational age-matched values from nomograms. One-sample t-test, ANOVA and repeated measures analysis were used to assess HC, VD and CI after fetal repair.


RESULTS
Preoperatively, the HC in fetuses with myelomeningocele was smaller than control values (186.4 vs. 198.8 mm, P = 0.0004). Eight weeks' postoperatively this difference had resolved (293 vs. 301.6 mm, P = 0.76). The mean increase in CI after repair was 20% (P = 0.02) compared with the predicted 51% in normal cases. The average increase in VD was 3.9 mm (38.8%, P < 0.001).


CONCLUSIONS
Mid-gestational repair of myelomeningocele alters fetal head growth. Increased CI suggests HC changes are not due to ventriculomegaly alone.
Danzer
E
E
The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Johnson
M P
MP
Wilson
R D
RD
Flake
A W
AW
Hedrick
H L
HL
Sutton
L N
LN
Adzick
N S
NS
D000328:Adult; D000704:Analysis of Variance; D001699:Biometry / Q000379:methods; D005260:Female; D005315:Fetal Diseases / Q000473:pathology* / Q000601:surgery; D005865:Gestational Age; D006801:Humans; D008591:Meningomyelocele / Q000196:embryology / Q000473:pathology* / Q000601:surgery; D011181:Postnatal Care / Q000379:methods; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*