Spinal hemorrhages are associated with early neonatal motor function loss in human spina bifida aperta

D.A. Sival, R.J. Verbeek, O.F. Brouwer, K.M. Sollie, A.F. Bos, W.F.A. den Dunnen Spinal hemorrhages are associated with early neonatal motor function loss in human spina bifida aperta Early Human Development, Volume 84, Issue 7, July 2008, Pages 423-431

Background: In spina bifida aperta (SBA), leg movements caudal to the meningomyelocele are present in utero, but they disappear shortly after birth. It is unclear whether leg movements disappear by impact of the neuro-developmental malformation or by superimposed traumatic damage. If superimposed traumatic damage is involved, targeted fetal intervention could improve motor outcome.

Aim: To characterize neuromuscular pathology in association with perinatal motor function loss in SBA.

Patients/methods: In fetal SBA (n=8; 16–40 weeks GA), themedian time interval between ultrasound registrations of fetal motor behavior and post-mortem histology was 1 week. Histology was assessed cranial, at and caudal to the meningomyelocele and compared with findings in fetal controls (n=4).

Results: Despite fetal movements caudal to the meningomyelocele (5/6), histology indicated muscle fiber alterations (6/6) that concurred with neuro-developmental and traumatic spinal defects [Neuro-developmental defects: spinal ependymal denudation (3/8), reduced amount of (caspase3-negative) lower motor neurons (LMNs; 8/8), aberrant spinal vascularization (8/8). Traumatic defects: gliosis (7/8), acute/fresh spinal hemorrhages near LMNs (8/8)].

Key words: Spina bifida; Histology; Motor neuron; Spinal hemorrhage; Ependymal denudation; Fetal movement