Fetal Surgery for Open Spina Bifida in Canada: Initial Results

Pruthi, Vagisha; Abbasi, Nimrah; Ryan, Greg; Drake, James M.; Kulkarni, Abhaya V.; Kwan-Wong, Terence; Phillips, John H.; Thakur, Varsha; Church, Paige; Diambomba, Yenge; Kelly, Edmond; Vermeersch, Leslie; Pollard, Lindsay; Carvalho, José Carlos Almeida; Mieghem, Tim Van

doi:10.1016/j.jogc.2020.10.014

Cited by 9 publications

(20 citation statements)

References 26 publications

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“…Eligibility criteria for the prenatal‐repair group that underwent in‐utero spina bifida closure were the same as those used by the Management of Myelomeningocele Study 3 , except that the upper maternal body‐mass‐index cut‐off for fetal surgery was set at 40 rather than 35 kg/m 2 . The surgical protocol and outcomes of this cohort have been published previously 7 .…”

Section: Methodsmentioning

confidence: 99%

“…Fetuses with open spina bifida undergoing conservative prenatal management with postnatal treatment of NTD were included in a second group. These pregnancies originated mostly from the cohort prior to June 2017, when the fetal spina bifida repair program started at our institution, and also included cases ineligible for prenatal repair because of maternal or fetal contraindication (maternal comorbidities, previous preterm birth and multiple gestation) 7 .…”

Section: Methodsmentioning

confidence: 99%

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Correlation of fetal ventricular size and need for postnatal cerebrospinal fluid diversion surgery in open spina bifida

Agrawal

AlRefai

Abbasi

et al. 2022

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?This study on fetuses with open spina bifida supports the previous finding of an association between the timing of closure (prenatal or postnatal) and the need for postnatal cerebrospinal fluid (CSF) diversion. Our findings also demonstrate that ventriculomegaly is associated independently with the need for postnatal CSF diversion, irrespective of timing of closure. Fetal ventriculomegaly progresses at a similar rate in fetuses with open spina bifida that undergo prenatal closure and those that undergo postnatal closure. What are the clinical implications of this work?The findings of this study should help in clinical counseling regarding the need for postnatal CSF diversion in patients undergoing fetal or postnatal spina bifida closure.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Correlation of fetal ventricular size and need for postnatal cerebrospinal fluid diversion surgery in open spina bifida

Agrawal

AlRefai

Abbasi

et al. 2022

Ultrasound in Obstet & Gyne

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show abstract

“…The Management of Myelomeningocele Study (MOMS) trial established both the benefits and risks of fetal surgery for open spinal dysraphism 1 . A decade after its publication, this intervention is being offered in a growing number of countries throughout the world and the advantages of prenatal spina bifida repair have been validated in several experienced centers 2‐9 …”

Section: Introductionmentioning

confidence: 99%

“…1 A decade after its publication, this intervention is being offered in a growing number of countries throughout the world and the advantages of prenatal spina bifida repair have been validated in several experienced centers. [2][3][4][5][6][7][8][9] The rationale for fetal surgery of open fetal dysraphism is based on the "two-hit" hypothesis, which states that in addition to the primary neurulation defect during embryogenesis, a significant portion of the postnatal functional handicap seen in patients with open spina bifida (OSB) is attributable to further accumulative damage to the neural cord due to mechanical and chemical injury, especially during the third trimester, leading to motor deterioration. [10][11][12][13] The effect of covering the defect to stop tissue destruction and cerebrospinal fluid leakage was demonstrated initially in several animal models, 14,15 leading to the first human cases in the late 90s.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of late open fetal surgery for intrauterine spina bifida repair after 26 weeks. Should we extend the Management of Myelomeningocele Study time window?

et al. 2022

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Objective To evaluate maternal and perinatal outcomes of late open fetal repair for open spina bifida (OSB) between 26+0–27+6 weeks. Methods A cohort of fetuses with OSB who underwent open surgery in two fetal surgery centers (Argentina and Mexico). Two groups were defined based on the gestational age (GA) at intervention: Management of Myelomeningocele Study (MOMS) time window group: GA 19+0–25+6, and late intervention group: GA 26+0–27+6. Results Intrauterine OSB repair was successfully performed in 140 cases, either before (n = 57) or after (n = 83) 26 weeks, at on average 25+0 (22+6–25+6) and 26+5 (26+0–27+6) weeks + days, respectively. There were no significant differences in the rate of premature rupture of membranes, chorioamnionitis, oligohydramnios, preterm delivery, perinatal death and maternal complications. The late intervention group showed a significantly lower surgical times (112.6 vs. 124.2 min, p = 0.01), lower interval between fetal surgery and delivery (7.9 vs. 9.2 weeks, p < 0.01) and similar rate of hydrocephalus requiring treatment (30.6% vs. 23.3%, p = 0.44) than the MOMS time window group. Conclusion Late fetal surgery for OSB repair between 26+0–27+6 weeks is feasible and was associated with similar outcomes than that performed before 26 weeks. These findings may allow an extension of the proposed time window for cases with late diagnosis or referral.

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“…(21,24,28,29, 40, 46, 52, 64,73,77, 84,90,91,93,99, 105, 114, 115, 120, 134,137,149,155, 173). Sixty-four studies, with 3,032 pregnancies, resulted in an aggregated mean GA at delivery of 33.39 weeks (11, 22, 27-29, 33, 39, 40, 46, 50, 51, 58, 61, 64, 65, 69, 73-78, 80, 81, 87, 90-93, 94, 96, 99, 101, 102, 105, 107, 113-117, 120, 122, 130-134,…”

mentioning

confidence: 99%

Anesthesia for fetal operative procedures: A systematic review

et al. 2022

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ObjectiveThe anesthetic management of fetal operative procedures (FOP) is a highly debated topic. Literature on fetal pain perception and response to external stimuli is rapidly expanding. Nonetheless, there is no consensus on the fetal consciousness nor on the instruments to measure pain levels. As a result, no guidelines or clinical recommendations on anesthesia modality during FOP are available. This systematic literature review aimed to collect the available knowledge on the most common fetal interventions, and summarize the reported outcomes for each anesthetic approach. Additional aim was to provide an overall evaluation of the most commonly used anesthetic agents.MethodsTwo systematic literature searches were performed in Embase, Medline, Web of Science Core Collection and Cochrane Central Register of Controlled Trials up to December 2021. To best cover the available evidence, one literature search was mostly focused on fetal surgical procedures; while anesthesia during FOP was the main target for the second search. The following fetal procedures were included: fetal transfusion, laser ablation of placental anastomosis, twin-reversed arterial perfusion treatment, fetoscopic endoluminal tracheal occlusion, thoraco-amniotic shunt, vesico-amniotic shunt, myelomeningocele repair, resection of sacrococcygeal teratoma, ligation of amniotic bands, balloon valvuloplasty/septoplasty, ex-utero intrapartum treatment, and ovarian cyst resection/aspiration. Yielded articles were screened against the same inclusion criteria. Studies reporting anesthesia details and procedures’ outcomes were considered. Descriptive statistical analysis was performed and findings were reported in a narrative manner.ResultsThe literature searches yielded 1,679 articles, with 429 being selected for full-text evaluation. A total of 168 articles were included. Overall, no significant differences were found among procedures performed under maternal anesthesia or maternal-fetal anesthesia. Procedures requiring invasive fetal manipulation resulted to be more effective when performed under maternal anesthesia only. Based on the available data, a wide range of anesthetic agents are currently deployed and no consistency has been found neither between centers nor procedures.ConclusionsThis systematic review shows great variance in the anesthetic management during FOP. Further studies, systematically reporting intraoperative fetal monitoring and fetal hormonal responses to external stimuli, are necessary to identify the best anesthetic approach. Additional investigations on pain pathways and fetal pain perception are advisable.

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Fetal Surgery for Open Spina Bifida in Canada: Initial Results

Cited by 9 publications

References 26 publications

Correlation of fetal ventricular size and need for postnatal cerebrospinal fluid diversion surgery in open spina bifida

Correlation of fetal ventricular size and need for postnatal cerebrospinal fluid diversion surgery in open spina bifida

Outcomes of late open fetal surgery for intrauterine spina bifida repair after 26 weeks. Should we extend the Management of Myelomeningocele Study time window?

Anesthesia for fetal operative procedures: A systematic review

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