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. 2025 Jul 9;41(1):226.
doi: 10.1007/s00381-025-06866-6.

Clinical impact of fetal sac size on closed neural tube defects

Sierra D Land  1 , Taryn Gallagher  1 , Sanjana R Salwi  1 , Tom A Reynolds  1 , Leny Mathew  1 , Edward R Oliver  1   2 , Dana A Weiss  3 , Tracy M Flanders  1   4 , Juliana S Gebb  1 , N Scott Adzick  1   5 , Gregory G Heuer  6   7
Affiliations

Clinical impact of fetal sac size on closed neural tube defects

Sierra D Land et al. Childs Nerv Syst. .

Abstract

Purpose: To evaluate the association between lesion volume and postnatal outcomes in patients with closed spina bifida (SB).

Methods: Single-center retrospective review of all patients diagnosed with a closed SB evaluated between 2013 and 2023. Prenatal lesion volume < 3 mL was categorized as "no sac," and volume ≥ 3 mL was categorized as "sac."

Results: 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%, p = 0.02). Lipomyelomeningocele patients demonstrated less prenatal lesion growth compared to myelocystocele patients (6.26 vs. 58.0 mL) over a median of 12.7 and 10.5 weeks, respectively. Patients with a sac had a higher proportion of talipes (40.9% vs. 9.1%; p = 0.007) compared to those without. At 5 years 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.

Conclusions: 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.

Keywords: Lipomyelomeningocele; Myelocystocele; Neural tube defects; Tethered cord.

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Conflict of interest statement

Declarations. Conflict of interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A Histogram of lesion volume and B cohort diagram
Fig. 2
Fig. 2
Imaging of sac and no sac defects. A Prenatal MRI of 21-week fetus with myelocystocele (sac) defect. B Prenatal ultrasound of the sagittal spine of the same fetus from image A. C Prenatal MRI of 21-week fetus with lipomyelomeningocele (no sac) defect. D Prenatal ultrasound of the sagittal spine of the same fetus from image C. E Postnatal MRI of 3-month-old with meningocele (no sac) defect. F Postnatal MRI of 1-day-old with meningocele (sac) defect
Fig. 3
Fig. 3
Prenatal lesion volume by diagnosis
Fig. 4
Fig. 4
Follow-up cohort A spina bifida follow-up clinic. B VUDS cohort. C Surgical cohort
See this image and copyright information in PMC

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