Table 1 Comparison of neurological, neurosurgical and neonatal characteristics between large and non-large myelomeningocele in the entire cohort.

From: Impact of the volume of the myelomeningocele sac on imaging, prenatal neurosurgery and motor outcomes: a retrospective cohort study

 

Large lesions

(n = 23)

Non-large lesions

(n = 40)

pa

Maternal age (years)

27.4 ± 5.7

30.1 ± 6.5

0.10

Body mass index

25.8 ± 4.6

26.8 ± 4.3

0.40

Race (white)

22/23 (96)

36/40 (90)

0.64

Ethnicity (hispanic)

6/23 (26)

8/40 (20)

0.58

Pre-operative MRI evaluation

Gestational age at the time of referral (weeks)

23.4 (19–25.5)

23 (18–25.7)

0.42

Volume of the lesion (cc)

4.5 (3–44.5)

1 (0.05–2.4)

 < 0.01

Anatomical level of the lesion ≥ L2 (%)

7/23 (30)

8/40 (20)

0.35

Mean size of bilateral posterior ventricular horns at referral (mm)

11.5 (7–18)

12 (6–18)

0.81

Ventriculomegaly defined as mean of posterior horn width > 10 mm (%)

16/23 (70)

26/40 (65)

0.71

Severe ventriculomegaly defined as mean of posterior horn width > 15 mm (%)

5/23 (22)

9/40 (22)

0.94

Clubfeet at referral (at least one foot, %)

13/23 (56)

4/40 (10)

 < 0.01

Pre-operative US motor function evaluation

Intact motor function (first sacral level) at the time of referral (%)

12/23 (52)

33/40 (17)

 < 0.01

Motor function at the time of referral (metameric level)

L4 (L1-S1)

S1 (L1-S1)

 < 0.01

Gestational age at the time of pre-operative US motor function evaluation (weeks)

23.4 (18.7–25.5)

23.0 (18–25.7)

0.41

Surgery

Gestation age at the time of surgery (weeks)

25.3 (24–25.9)

24.6 (21.3–26)

 < 0.01

Interval between time of pre-operative MRI and surgery (weeks)

1.5 (0.1–7)

1.4 (0.1–7.9)

0.72

Fetoscopic repair technique (%)

14/23 (69)

23/40 (55.3)

0.79

Duration of surgery (min)

250 (129–394)

202 (94–356)

0.18

Need for relaxing incisions (%)

3/23 (13)

4/40 (10)

0.70

Post-operative MRI evaluation

Gestational age of post-operative MRI (weeks)

30.6 (28–33)

30.4 (27–35)

0.37

Hindbrain herniation severityb

1 (0–3)

1 (0–3)

0.97

Reversal of hindbrain herniation after surgery (%)

13/19 (68)

28/35 (80)

0.34

Ventricle size after surgery (mm)

15.5 (10–26.5)

16 (6–23)

0.94

Ventriculomegaly defined as mean of posterior horn width > 10 mm (%)

19/19 (100)

32/37 (86)

0.15

Severe ventriculomegaly defined as mean of posterior horn width > 15 mm (%)

10/19 (53)

24/37 (65)

0.37

Post-operative US motor function evaluation

Gestational age at the time of US motor function evaluation 6 weeks after the surgery (weeks)

30.6 (28.5–33)

30.4 (26.2–35)

0.92

Intact motor function 6 weeks after the surgery (%)

9/19 (47)

24/35 (69)

0.92

Motor function 6 weeks after the surgery (metameric level)

L4 (L1-S1)

S1 (L1-S1)

0.14

Gestational age at the time of the last US motor function evaluation before delivery (weeks)

36.0 (32–39)

34.9 (30–40)

0.18

Intact motor function at last US scan before delivery (%)

5/12 (42)

19/24 (79)

0.02

Motor function at last US scan before delivery (metameric level)

L4 (L1-S1)

S1 (L1-S1)

0.04

Neonatal outcomes

Gestational age at delivery (weeks)

36 (26–40)

36.3 (27.3–40.6)

0.87

Female gender (%)

7/23 (30)

21/40 (52)

0.09

Birth weight (grams)

2575 (870–3745)

2665 (624–4430)

0.55

Dehiscence or leakage of CSF at birth (%)

2/23 (9)

10/40 (25)

0.11

Need for postnatal repair at birth (%)

2/23 (9)

8/40 (20)

0.24

Intact motor function (first sacral motor level) at birth (%)

6/23 (26)

28/40 (70)

 < 0.01

Motor function at birth (metameric level)

L4 (L1-S1)

S1 (L1-S1)

 < 0.01

Clubfeet at birth (%)

13/23 (56)

7/40 (17)

 < 0.01

Need for hydrocephalus treatment in the first year of life (%)c

6/19 (32)

11/38 (29)

0.84

Independent ambulation (with or without orthotics) at 30 months of age (%)

3/12 (25)

13/26 (50)

0.15

Intact motor function (first sacral motor level) at 12 months of life

4/12 (33)

16/24 (67)

0.06

  1. Large lesion was defined when volume was > 2.7 cc.
  2. L2, second lumbar vertebrae; CSF, cerebrospinal fluid;
  3. aRepresents the comparisons between the large and non-large lesion group. Quantitative data were expressed as mean ± standard deviation if normal distribution or median (range) if non-normal distribution (as detected by Kolmogorov–Smirnov). Quantitative variables were compared using t-test for independent samples if there was a normal distribution. If a non-normal distribution was present non-parametric tests were used (Mann–Whitney U test). Qualitative variables were compared using Chi-square or Fisher’s exact test. A p-value < 0.05 was considered significant.
  4. bGrade 0 (normal); grade 1 (visible fourth ventricle and cisterna magna without cerebellar displacement below the foramen magnum, tentorium could be vertically oriented, and tectal beaking could be present); grade 2 (visible cisterna magna without displacement of cerebellum below the foramen magnum, no visible fourth ventricle); grade 3 (cerebellar ectopia below the foramen magnum and obliteration of all posterior fossa CSF spaces).
  5. cHydrocephalus treatment: including ETV and/or ventriculoperitoneal shunt.
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