{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T01:41:50Z","timestamp":1784770910752,"version":"3.55.0"},"reference-count":19,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,6,15]],"date-time":"2020-06-15T00:00:00Z","timestamp":1592179200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100015158","name":"Fondren Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015158","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>(1) To compare brain findings between large and non\u2010large neural tube defect (NTD); (2) to evaluate the impact of large lesion on the surgical parameters; (3) to study any associations between the size of the lesions and brain findings 6\u00a0weeks postoperatively and neurological short\u2010term outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Texas Children\u2019s Hospital, between 2011 and 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Patients who underwent prenatal NTD repair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Large lesion was defined when the lesion\u2019s surface was &gt;75th centile of our cohorts\u2019 lesions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Time of referral: ventriculomegaly and anatomical level of the lesion; surgery: duration and need for relaxing incisions. 6\u00a0weeks postoperative: hindbrain herniation (HBH) and ventriculomegaly. After delivery: dehiscence, need for hydrocephalus treatment and motor function.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 99 patients were included, 25 of whom presented with large lesions. Type of lesion and ventriculomegaly were comparable between individuals with large and non\u2010large lesions. Individuals with large lesions were associated with increased need for relaxing incisions by 5.4 times (95% CI 1.3\u201323.2, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.02). Six weeks postoperatively, having a large lesion decreased by ten times the likelihood of having a postoperative reversal of HBH (odds ratio\u00a0=\u00a00.1, 95% CI 0.1\u20130.4, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01). At birth, larger lesions increased the risk for repair dehiscence by 6.1 times (95% CI 1.6\u201322.5, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01) and the risk of dehiscence or leakage of cerebrospinal fluid at birth by 5.5 times (95% CI 1.6\u201318.9, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Prenatal repair of patients with large NTD presents a lower proportion of HBH reversal 6\u00a0weeks after the surgery, a higher risk of dehiscence and a higher need for postnatal repair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Evaluation of the size of fetal NTD can predict adverse neurological outcomes after prenatal NTD repair.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.16316","type":"journal-article","created":{"date-parts":[[2020,5,14]],"date-time":"2020-05-14T11:07:14Z","timestamp":1589454434000},"page":"392-399","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Impact of the size of the lesion in prenatal neural tube defect repair on imaging, neurosurgical and motor outcomes: a retrospective cohort study"],"prefix":"10.1111","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8583-2054","authenticated-orcid":false,"given":"R","family":"Corroenne","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Texas Children\u2019s Hospital &amp; Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3871-7747","authenticated-orcid":false,"given":"KH","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Texas Children\u2019s Hospital &amp; Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Texas Children\u2019s Hospital &amp; Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Texas Children\u2019s Hospital &amp; Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"WE","family":"Whitehead","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Texas Children\u2019s Hospital &amp; Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Espinoza","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Texas Children\u2019s Hospital &amp; Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Castillo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Texas Children\u2019s Hospital &amp; Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Castillo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Texas Children\u2019s Hospital &amp; Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Orman","sequence":"additional","affiliation":[{"name":"E. B. Singleton Department of Pediatric Radiology Texas Children\u2019s Hospital &amp; Department of Radiology Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"TAGM","family":"Huisman","sequence":"additional","affiliation":[{"name":"E. B. Singleton Department of Pediatric Radiology Texas Children\u2019s Hospital &amp; Department of Radiology Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AR","family":"Mehollin\u2010Ray","sequence":"additional","affiliation":[{"name":"E. B. Singleton Department of Pediatric Radiology Texas Children\u2019s Hospital &amp; Department of Radiology Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AA","family":"Shamshirsaz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Texas Children\u2019s Hospital &amp; Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AA","family":"Nassr","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Texas Children\u2019s Hospital &amp; Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MA","family":"Belfort","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Texas Children\u2019s Hospital &amp; Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0265-9859","authenticated-orcid":false,"given":"M","family":"Sanz Cortes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Texas Children\u2019s Hospital &amp; Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,15]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"1","article-title":"Updated estimates of neural tube defects prevented by mandatory folic acid fortification \u2013 United States, 1995\u20132011","volume":"64","author":"Williams J","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1014379"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/nm0495-342"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2000.108867"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000028898"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001941"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19001"},{"key":"e_1_2_7_9_1","unstructured":"Fetoscopic Meningomyelocele Repair Study (fMMC) [Internet]. 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