OC03.08: Need for surgical treatment of hydrocephalus in children with open spina bifida: comparison between late open fetal surgery and neonatal repair

To compare the rate of hydrocephalus needing surgical treatment in children with open spina bifida treated with late open fetal surgery above 26 weeks and those undergoing postnatal surgical repair. A retrospective cohort of fetuses affected with open spina bifida and Arnold-Chiari II malformation, treated with open fetal surgery between 26 and 29 weeks' gestation in a single fetal surgery centre in Mexico, were matched with a control group receiving neonatal surgical repair. The rate of hydrocephalus and need for ventriculo-peritoneal shunting (VPS) and/or neonatal neuroendoscopy for third ventriculostomy were compared between the study groups. During the 7-year study period, 40 cases were successfully treated with open fetal surgery at a median gestational age of 27.1 (26.0 to 29.0) weeks and compared with 53 cases managed with postnatal surgical repair. Fetal surgery was associated with significantly lower gestational age at birth (34.4 vs. 38.0 weeks, p < 0.01), lower frequency of neonatal hydrocephalus (13.2% vs. 85%, p < 0.01), and lower need for VPS (5.7% vs. 66.7%, p < 0.01) or neonatal neuroendoscopy for third ventriculostomy (7.5% vs. 18.3%, p = 0.09). Late open intrauterine spina bifida repair after 26 weeks is associated with lower rate of hydrocephalus needing surgical treatment than postnatal surgical repair.