2023-11-22 17:00:28
The main cause of childhood disability is open spina bifida and its prevalence is 4 to 5 cases per 10 thousand births. . It can be stated that it is the most common congenital anomaly of neura tube defects and affects 9.2 out of every 100 thousand newborns in Mexico. The open type can be detected in the structural ultrasound of the first trimester; most cases are discovered in routine morphological ultrasound, around 20 weeks of gestation.
Prenatal diagnosis of spina bifida
In 1989, two intracranial signs were described for the indirect diagnosis of open spina bifida, which are:
lemon sign: identification of the deformation of the silhouette of the skull, which acquires a characteristic morphology that simulates a lemon:
banana sign: The cerebellum changes its typical figure-of-eight morphology towards a banana-shaped morphology.
Forecast
The prognosis for this type of neural tube defect varies depending on the type of spina bifida (open or closed). In general, the closed one has a good prognosis and does not usually manifest ventriculomegaly, herniation of brain structures or motor damage. On the contrary, the open type occurs during primary neurulation, exposing the spinal cord to amniotic fluid, which causes inflammation and progressive neuronal loss; Consequently, neurological damage begins and progresses during fetal life.
Spina bifida treatment
Typically, the treatment of cases of spina bifida consists of birth by cesarean section at around 38-39 weeks, with surgical repair of the defect after birth. In 80 percent of cases, a ventriculoperitoneal shunt valve to treat secondary hydrocephalus.
The first attempt at intrauterine repair of open spina bifida was reported by Bruner et al. For this, they carried out open fetal surgery, carried out by laparotomy. It is true that, in order to reduce obstetric risks and associated complications, the original technique has undergone modifications.
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