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Prenatal lesion volume\u2009&lt;\u20093\u00a0mL was categorized as \u201cno sac,\u201d and volume\u2009\u2265\u20093\u00a0mL was categorized as \u201csac.\u201d<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of eligible patients, 22 had a sac, and 33 did not. Myelocystocele patients more commonly had an associated saccular lesion than lipomyelomeningoceles (80% vs. 28%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). Lipomyelomeningocele patients demonstrated less prenatal lesion growth compared to myelocystocele patients (6.26 vs. 58.0\u00a0mL) over a median of 12.7 and 10.5\u00a0weeks, respectively. Patients with a sac had a higher proportion of talipes (40.9% vs. 9.1%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007) compared to those without. At 5\u00a0years old, a higher proportion of patients with no sac was able to ambulate independently and required less CIC than patients with a sac (80% vs. 42%; 0% vs. 41.7%). VUDS showed a greater frequency of detrusor overactivity (60.0% vs. 45.0%) and abnormal bladder compliance (60.0% vs. 5.0%) in those with a sac compared to those without. Repeat tethered cord release was also more common (30.0% vs. 3.4%) among patients with a sac-associated defect.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with a sac had an increased risk of prenatal talipes, decreased ability to ambulate independently, increased use of CIC, and increased need for repeat tethered cord release compared to patients without a sac. Given numerous associated morbidities reported in this study, longitudinal multidisciplinary follow-up is critical in the care of these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00381-025-06866-6","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T10:02:57Z","timestamp":1752141777000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical impact of fetal sac size on closed neural tube defects"],"prefix":"10.1007","volume":"41","author":[{"given":"Sierra D.","family":"Land","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taryn","family":"Gallagher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjana R.","family":"Salwi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom A.","family":"Reynolds","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leny","family":"Mathew","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward R.","family":"Oliver","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana A.","family":"Weiss","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracy M.","family":"Flanders","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliana S.","family":"Gebb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N. 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