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Prenatal diagnosis of open and closed spina bifida

2006; Wiley; Volume: 28; Issue: 7 Linguagem: Inglês

10.1002/uog.3865

1469-0705

T. Ghi, G. Pilu, Pietro Falco, M. Segata, A. Carletti, G Cocchi, Donatella Santini, Maria Paola Bonasoni, G. Tani, N. Rizzo,

Prenatal Screening and Diagnostics

To identify criteria useful for differentiating closed from open spina bifida antenatally.A retrospective study of cases of spina bifida diagnosed in a referral center between 1997 and 2004.Of 66 cases of fetal spina bifida diagnosed at a median gestational age of 21 (range, 16-34) weeks, detailed follow-up was available for 57. Of these, open defects were found in 53 (93.0%) and closed defects in four (7.0%). Closed spina bifida was associated in two cases with a posterior cystic mass with thick walls and a complex appearance, while in two cases the spinal lesion could not be clearly differentiated from an open defect, particularly at mid-gestation. Open spina bifida was always associated with typical alterations of cranial anatomy, including the so-called 'banana' and 'lemon' signs, while in closed spina bifida the cranium was unremarkable. When the data were available, levels of amniotic fluid alpha-fetoprotein were always abnormally elevated with open spina bifida and within normal limits with closed forms.In this study 7% of cases of spina bifida diagnosed in utero were closed. The differentiation between open and closed forms is best shown by the sonographic demonstration of abnormal or normal cranial anatomy.