Endoscopic coverage of fetal myelomeningocele in utero

Bruner, Joseph P.; Richards, William O.; Tulipan, Noel; Arney, T.L.

doi:10.1016/s0002-9378(99)70167-5

Cited by 199 publications

(125 citation statements)

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“…Close cooperation with plastic surgery team has allowed optimal surgical repair and minimal neurological deficit [2,[11][12][13]. Endoscopic coverage of foetal myelomeningocele in utero is recently and widely performed by many surgeons but its benefits on neurological recovery has not been understood yet [14,15]. Amniotic fluid exchange was also previously reported by Olguner et al [16] and they concluded that the exposure of myelomeningocele to amniotic fluid causes structural neural tissue damage that can be prevented by amniotic fluid exchange.…”

Section: Discussionmentioning

confidence: 95%

Evaluation and Management of Lumbosacral Myelomeningoceles in Children

Kural¹,

Solmaz²,

Tehli³

et al. 2015

Eurasian J Med

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Objective: Myelomeningoceles are the common form of open neural tube defects that are usually associated with neurological deficits. Many techniques of repair and methods of prevention have been proposed with respect to the size of defect and the neurological condition of patient. The aim of this study was to report our experience on the management of lumbosacral myelomeningoceles in children. Materials and Methods:We retrospectively analysed the data of 36 paediatric cases of surgically lumbosacral myelomeningocele treated in our department between 1998 and 2013. Twenty (56%) patients were female and sixteen were male, with a mean age of 4 months (ranged between 0 and 24 months). All patients had neurological deficits in the preoperative period. Computed tomography was performed in 33 (92%) patients and magnetic resonance imaging in 15 (42%) patients in the preoperative period. Repair of the myelomeningocele and closure of the skin defect were performed in all patients. The mean follow-up period was 36 months.Results: Thirty (83%) patients were operated for hydrocephalus and 10 (28%) patients were re-operated for tethered cord syndrome during the follow-up period. Neurological worsening was not observed in any patient while cerebrospinal fluid fistula was detected in 2 patients. Conclusion:Surgical treatment using appropriate microsurgical techniques is crucial for lumbosacral myelomeningoceles in children. Early surgical intervention with close follow-up will improve the neurological condition of the patients. Keywords: Myelomeningocele, surgery, child ÖzetAmaç: Myelomeningoseller açık nöral tüp defektlerinin sık görülen bir formu olup sıklıkla nörolojik defisitler eşlik eder. Myelomeningoselin boyutuna ve hastanın nörolojik tablosuna göre pek çok tamir metodları ve önleme yöntemleri önerilmiştir. Bu çalışmanın amacı kliniğimizde lumbosakral myelomeningosel nedeniyle opere edilen çocuklarla ilgili tecrübemizi sunmaktır. Gereç ve Yöntem:Bu makalede kliniğimizde 1998 ile 2013 yılları arasında cerrahi yöntemle tedavi edilmiş olan 36 adet pediatrik lumbosakral myelomeningosel olgusunun verileri retrospektif olarak incelenmiştir. Hastaları 20 (%56) tanesi erkek, 16 tanesi kızdır ve ortalama yaş 4 aydır (0-24 ay). Tüm hastalarda preoperatif dönemde nörolojik defisit vardı. Ameliyat öncesi bilgisayarlı tomografi 33 (%92) hastaya, manyetik rezonans görüntüleme ise 15 (%42) hastaya uygulanmıştır. Myelomeningosel kesesinin tamiri ve cildin kapatılması tüm hastalarda standard cerrahi yöntemdir. Ortalama takip süresi 36 aydır. Bulgular: Otuz (%83) hasta hidrosefali nedeniyle opere edilmiş, 10 (%28) hasta ise daha sonraki dönemde gergin omurilik sendromu tanısı ile reopere edilmiştir. Hiçbir hastada cerrahi sonrasında nörolojik kötüleşme olmamış, 2 hastada beyin-omurilik sıvısı fistülü gelişmiştir.Sonuç: Çocuklarda lumbosakral myelomeningosellerin uygun mikrocerrahi yöntemlerle cerrahi tedavisi çok önemlidir. Erken cerrahi girişim ile birlikte yakın izlem hastaların nörolojik tablolarında düzelme sağlayabilmektedir.

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Section: Discussionmentioning

confidence: 95%

Evaluation and Management of Lumbosacral Myelomeningoceles in Children

Kural¹,

Solmaz²,

Tehli³

et al. 2015

Eurasian J Med

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“…We use warmed, isotonic Hartmann solution, which has been proven to be safe in experimental and clinical conditions [41,42]. Gas distension (CO 2 , N 2 O) may permit a clearer view, even in the presence of bleeding, yet interferes with the use of ultrasound and some fear fetal side effects [43][44][45][46]. The camera system and light sources are no different from other endoscopic operations, though the light cables are smaller in diameter.…”

Section: Instrumentsmentioning

confidence: 99%

The use of endoscopy in fetal medicine

Beck¹,

Pexsters²,

Gucciardo³

et al. 2010

Gynecol Surg

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We aimed to review the state of affairs in the field of embryo-fetoscopy as well as its instrumental requirements. Today, endoscopic procedures of limited complexity are easily possible within the amniotic cavity. Embryoscopy is typically done for diagnostic purposes, such as the demonstration of external anomalies very early in pregnancy and/or obtaining embryonic tissues in recurrent miscarriages. Fetoscopy is the direct visualization of the amniotic cavity from the second trimester onwards. Its principal indications are complications of monochorionic twinning and severe congenital diaphragmatic hernia. There is level I evidence that fetoscopic laser surgery for twintwin-transfusion syndrome is superior over amniodrainage. Fetoscopic endoluminal tracheal occlusion is done for severe diaphragmatic hernia. Whether tracheal occlusion yields better outcomes than expectant management during pregnancies is currently being investigated in a randomized trial. There are a number of less common procedures discussed as well. Overall, maternal risks of embryofetoscopy are minimal. The most frequent complication is rupture of the membranes and as a consequence preterm delivery. Fetal surgery seems safe and has, therefore, become a clinical reality. Although the stage of technical experimentation is over, most interventions remain investigational. Inclusion of patients into trials whenever possible should be encouraged, rather than building up casuistic experience.

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“…Attempt to repair myelomeningocoele endoscopically has been described using carbon dioxide (amniotic fluid removed) and maternal skin craft as the patch material. 36 The results of open surgery for this procedure is yet to be challenged. 37 There is work reported in animals on fetoscopic management of aortic and pulmonary stenosis.…”

Section: Other Proceduresmentioning

confidence: 99%