title: Prenatal diagnosis and postnatal outcome of fetal spinal defects without Arnold-Chiari II malformation.
abstract: OBJECTIVE
  To determine the prenatal evolution/natural history and postnatal outcome of fetuses diagnosed with a neural tube defect (NTD) lacking the Arnold-Chiari-II malformation (ACM II).
  
  
  METHODS
  This retrospective study reviewed 16 fetuses evaluated with ultrasound (US) and MRI at a single referral center from 1/2000 to 8/2007. Follow-up studies and available postnatal outcomes were reviewed.
  
  
  RESULTS
  Postpartum diagnosis was terminal myelocystoceles 7/16 (44%); myelomeningoceles (MMCs) 3/16 (19%); lipomyelomeningoceles 2/16(13%); and thoracic myelocystocele 1/16 (6%). Three patients (19%) were lost to follow-up or termination of pregnancy. Two prenatally diagnosed 'closed' NTD were postnatally found to be MMCs. Three of the myelocystoceles had additional omphalocele, bladder extrophy, imperforate anus and spinal defect (OEIS complex). For the total cohort, impaired lower extremity function was seen in 38%, impaired bladder function in 64%, and ventriculoperitoneal shunting in 8%. Four fetuses with a myelocystocele developed hindbrain herniation in the third trimester of pregnancy. The preterm delivery rate was 38%. Five of eight (63%) neonates with postnatally diagnosed myelocystoceles had mothers with a body mass index over 30.
  
  
  CONCLUSIONS
  Prenatal differentiation between closed and open NTD is not always possible. Postnatal outcome of isolated myelocystocele and MMC seems to be more favorable than for an NTD with ACM II (shunt requirement). Incontinence is the major childhood morbidity. Maternal obesity may be a risk factor for closed NTDs.
authors.affiliation: Department of Obstetrics, University Hospital, Zürich, Switzerland.
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Hüsler
authors.forename: Enrico
authors.initials: E
authors.lastname: Danzer
authors.forename: Mark P
authors.initials: MP
authors.lastname: Johnson
authors.forename: Michael
authors.initials: M
authors.lastname: Bebbington
authors.forename: Leslie
authors.initials: L
authors.lastname: Sutton
authors.forename: N Scott
authors.initials: NS
authors.lastname: Adzick
authors.forename: R Douglas
authors.initials: RD
authors.lastname: Wilson
mesh_terms: D000015:Abnormalities, Multiple / Q000175:diagnosis; D001139:Arnold-Chiari Malformation / Q000150:complications / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008591:Meningomyelocele / Q000175:diagnosis; D009436:Neural Tube Defects / Q000150:complications / Q000175:diagnosis*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000150:complications / Q000151:congenital / Q000175:diagnosis; D013131:Spine / Q000002:abnormalities* / Q000000981:diagnostic imaging; D014463:Ultrasonography; D001745:Urinary Bladder Diseases / Q000150:complications / Q000151:congenital / Q000175:diagnosis