Structural and functional brain effects of prenatal spina bifida fetal repair

Spina bifida (SB) is one of the most frequent malformations occurring in fetal central  nervous system and it is correlated with several complications. Neurological impairments  as lower cognition level and structural brain abnormalities as midbrain herniation and  hydrocephalus have already been described over the past years. Currently, different surgical techniques have been tested aiming to achieve a better maternal and fetal outcome,  with recent studies showing to be in favour of fetal repair of SB instead of postnatal correction. However, almost all studies have focused on motor and cognitive functions, whereas few data has been published about  structural brain changes after fetal surgery.Our hypothesis is that SB is associated with structural brain changes apart from Chiari malformation and hydrocephaly that are already presented in some cases at the moment  of the diagnosis and are responsible for  poor cognitive outcomes. For that reason, we  will evaluate prenatal and postnatal MRI images of SB cases from different centres (Barcelona, Leuven and Sao Paulo) from the last 10 years. Cognitive tests will be performed in all studies cases in order to correlate the imaging findings with neurological  function. We also hypothesize that laparoscopic SB fetal repair will reduce the incidence of structural brain malformations and therefore postnatal outcomes. For that purpose,  standardized sheep model of SB will be used  to perform different prenatal surgical techniques for SB repair in University of Barcelona and University of Leuven, Belgium. High-resolution MRI will be performed in order  to assess brain structural abnormalities and  changes in white and grey matter development. Finally, brain structure will be also analyzed with histology to assess cortical architecture and white matter development.