Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial

Pedreira, D. A. L.; Zanon, Nelci; Nishikuni, Koshiro; Sá, Renato Augusto Moreira de; Acácio, Gregório Lorenzo; Chmait, Ramen H.; Kontopoulos, Eftichia V.; Quintero, Rubén A.

doi:10.1016/j.ajog.2015.09.065

Cited by 185 publications

(255 citation statements)

References 44 publications

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“…Outcomes of at least 20 patients are not mentioned in the 2014 series [26,27], and 3 patients mentioned in the 2014 studies are missing in the 2015 study, 1 who could not undergo closure and 2 who underwent double-layer closure using Surgisis® fascia patch covered by skin [35]. The data from the case series by Pedreira et al [37] are of good quality (table 1). Outcomes after 12 months are not available yet (table 2).…”

Section: Resultsmentioning

confidence: 98%

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Fetoscopic versus Open Repair for Spina Bifida Aperta: A Systematic Review of Outcomes

Joyeux

Engels²,

Russo³

et al. 2016

Fetal Diagn Ther

164

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Objective: To compare outcomes of fetoscopic spina bifida aperta repair (FSBAR) with the results of the open approach (OSBAR) as in the Management Of Myelomeningocele Study (MOMS). Methods: This was a systematic comparison of reports on FSBAR with data from the MOMS (n = 78). Inclusion criteria were studies of spina bifida aperta patients who underwent FSBAR and were followed for ≥12 months. Primary outcome was perinatal mortality. Secondary outcomes included operative, maternal, fetal, neonatal and infant outcomes. Results: Out of 16 reports, we included 5 from 2 centers. Due to bias and heterogeneity, analysis was restricted to two overlapping case series (n = 51 and 71). In those, FSBAR was technically different from OSBAR, had comparable perinatal mortality (7.8 vs. 2.6%, p = 0.212) and shunt rate at 12 months (45 vs. 40%, p = 0.619), longer operation time (223 vs. 105 min, p < 0.001), higher preterm prelabor membrane rupture rate (84 vs. 46%, p < 0.001), earlier gestational age at birth (32.9 vs. 34.1 weeks, p = 0.03), higher postnatal reoperation rate (28 vs. 2.56%, p < 0.001) and absence of uterine thinning or dehiscence (0 vs. 36%, p < 0.001). Functional outcomes were not available. Conclusion: FSBAR utilizes a different neurosurgical technique, takes longer to complete, induces more prematurity, requires additional postnatal procedures, yet has a comparable shunt rate and is not associated with uterine thinning or dehiscence. Long-term functional data are awaited.

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Section: Resultsmentioning

confidence: 98%

“…From the first program (Kohl and colleagues, Germany), we included patients from 4 overlapping reports: 1 published in 2012 (n = 19), 2 in 2014 (n = 51) and 1 final report in 2015 (n = 71) [22,26,27,35]. The fifth series (n = 10) came from Pedreira et al [37] (São Paulo, Brazil).…”

Section: Resultsmentioning

confidence: 99%

Fetoscopic versus Open Repair for Spina Bifida Aperta: A Systematic Review of Outcomes

Joyeux

Engels²,

Russo³

et al. 2016

Fetal Diagn Ther

164

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“…If neural tube defects occurred in a woman's previous pregnancy, increased antepartum foetal surveillance is required for the current pregnancy [3]. This surveillance should include consultation with a geneticist and targeted foetal ultrasonography to assess the foetal spine and cranium.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy with Myelomeningocele Foetus: A Case Study

SN¹

2017

BJSTR

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“…Nesse sentido, Botelho et al desenvolveram um aprimoramento da técnica cirúrgica a céu aberto com menor incisão uterina (mini-histerotomia), o que levou a menores taxas de RPMO, separação corioamniótica e deiscência da cicatriz uterina, além de menor taxa de prematuridade extrema (após 34 semanas) 34 . Trabalhos utilizando a via endoscópica também têm sido relatados 35,36,37 , mas com resultados ainda não superiores aos da técnica a céu aberto, necessitando de novos estudos para que as vias e técnicas possam ser comparadas de maneira adequada e satisfatória.…”

Section: Ii) Correção Intrauterina De Mielomeningoceleunclassified

Cirurgia fetal no contexto atual

Rocha

Filho

Bunduki

et al. 2018

Rev. Med. (São Paulo)

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RESUMO:A cirurgia fetal é, hoje, uma realidade em grandes centros especializados na área da medicina fetal. Surgiu por volta da década de 1960, inicialmente atrelada à necessidade de melhor conhecer e entender as patologias fetais, e teve desenvolvimento exponencial impulsionado pelo aprimoramento das técnicas diagnósticas pré-natais. Foi aos poucos se consolidando e tornando-se o tratamento de escolha para algumas patologias específicas, mudando definitivamente o curso dessas doenças. Nesse estudo, encontra-se um breve histórico das cirurgias fetais mais comumente realizadas em todo o mundo, como elas surgiram e como foram evoluindo com o passar do tempo, os principais estudos que as validaram e a técnica cirúrgica mais amplamente utilizada em cada caso. Entre as principais cirurgias, são citadas a fotocoagulação a laser de anastomoses placentárias na síndrome de transfusão feto-fetal, a correção intrauterina a céu aberto da mielomeningocele fetal e a oclusão endotraqueal fetal por balão nos casos de hérnia diafragmática congênita. Também são abordados cirurgias e procedimentos cujos benefícios são menos evidentes e os resultados ainda um tanto controversos, como as intervenções urinárias nos casos de obstrução ao trato urinário inferior, procedimentos cardíacos em casos de estenose aórtica crítica, derivações tóracoamnióticas para tratamento de derrames pleurais compressivos, além de ressecções intrauterinas de teratomas sacrococcígeos e de massas pulmonares. Também é feita uma avaliação a respeito do futuro da cirurgia fetal.Descritores: Feto/cirurgia; Fetoscopia. ABSTRACT:Fetal surgery is now a reality in large centers that specialize in the field of fetal medicine. Fetal surgery emerged in the 1960s, primarily from the need to better identify and understand fetal pathologies, and its exponential development was driven by improvements in prenatal diagnostic techniques. Fetal surgery gradually became the main treatment for specific fetal pathologies, changing the course of these diseases. This study summarizes the history of the fetal surgeries that are most commonly performed worldwide, how they started and how they evolved over time, the main validation trials and the most widely used surgical technique in each case. The main surgeries include laser photocoagulation of placental anastomoses in twin-to-twin transfusion syndrome, in utero repair of fetal myelomeningocele and fetal endotracheal occlusion in cases of congenital diaphragmatic hernia. Other surgeries and procedures, whose benefits are less clear and whose results are still somewhat controversial, such as urinary interventions in cases of lower urinary tract obstruction, cardiac procedures in cases of critical aortic stenosis, thoracoamniotic shunts for the treatment of massive pleural effusions and intrauterine resection of sacrococcygeal teratomas and pulmonary masses, are also cited. The future of fetal surgery is also assessed.

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Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial

Cited by 185 publications

References 44 publications

Fetoscopic versus Open Repair for Spina Bifida Aperta: A Systematic Review of Outcomes

Fetoscopic versus Open Repair for Spina Bifida Aperta: A Systematic Review of Outcomes

Pregnancy with Myelomeningocele Foetus: A Case Study

Cirurgia fetal no contexto atual

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