Giant Chorioangiomas: Perinatal Outcomes and Techniques in Fetoscopic Devascularization

Lim, Foong‐Yen; Coleman, Alan; Polzin, William; Jaekle, Ronald; Habli, Mounira; Hook, James Van; Lewis, David F.; Crombleholme, Timothy M.

doi:10.1159/000363600

Cited by 32 publications

(38 citation statements)

References 17 publications

(40 reference statements)

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“…Although fetoscopic devascularization by laser or bipolar coagulation has previously been described, the larger calibre and flow of feeding arteries in chorioangiomas vis-à-vis anastomotic vessels in twin-twin transfusion increase the risk of haemorrhage [3,4] . Embolization has thus become a more appealing option since it also occludes the feeding arteries without the aforementioned risk.…”

Section: Discussionmentioning

confidence: 99%

Call for Caution: Neonatal Portal Vein Thrombosis following Enbucrilate Embolization of Placental Chorioangioma

Voon

Amin²,

Kok³

et al. 2017

Fetal Diagn Ther

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We illustrate a case of giant placental chorioangioma presenting at 20 weeks of gestation. Subsequent monitoring revealed enlargement of the lesion, associated with fetal anemia and cardiac failure, prompting in utero intervention. Amnioreduction followed by percutaneous embolization of the tumour with enbucrilate:Lipiodol Ultra-Fluid™ at a dilution of 1:5 was successfully performed. No repeat intervention or additional supportive measures were required throughout pregnancy and the baby was delivered at 36 weeks of gestation, following spontaneous labour. Due to prolonged neonatal jaundice, further investigations were undertaken, demonstrating subacute right portal vein thrombosis. Other previously reported causes of neonatal portal vein thrombosis such as umbilical vein thrombosis, neonatal umbilical vein catheterization, thrombophilia and sepsis were excluded. There was resolution of the thrombus by 6 months of life. A brief discussion of measures to minimize the risk of such an event and the long-term outcomes of neonatal portal vein thrombosis was included. Whilst the simplicity and efficacy of the procedure has been demonstrated in a handful of patients, judgment on its safety is best deferred. Counselling should be comprehensive, as even rare complications can result in significant postnatal morbidity.

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Section: Discussionmentioning

confidence: 99%

Call for Caution: Neonatal Portal Vein Thrombosis following Enbucrilate Embolization of Placental Chorioangioma

Voon

Amin²,

Kok³

et al. 2017

Fetal Diagn Ther

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“…Fetoscopic surgical ligation of the feeding vessels is not practiced nowadays due to its high procedural risk and technical difficulties [3] . Fetoscopic laser coagulation, though promising in coagulating vascular anastomosis in twin-to-twin transfusion syndrome, is less effective with risks of vessel rupture and haemorrhage in chorioangiomas as their feeding arteries are larger and have higher blood flow [4,5] . Fetoscopic bipolar coagulation showed favourable neonatal outcomes in three cases, but it is usually an adjunct to additional procedures -to decrease flow to the main artery prior to laser photocoagulation [5] .…”

Section: Discussionmentioning

confidence: 99%

“…Fetoscopic laser coagulation, though promising in coagulating vascular anastomosis in twin-to-twin transfusion syndrome, is less effective with risks of vessel rupture and haemorrhage in chorioangiomas as their feeding arteries are larger and have higher blood flow [4,5] . Fetoscopic bipolar coagulation showed favourable neonatal outcomes in three cases, but it is usually an adjunct to additional procedures -to decrease flow to the main artery prior to laser photocoagulation [5] . Its limitations include the need of two entry ports (fetoscope and bipolar forceps) and the difficulty in grasping the feeding vessel when it is closely adherent to the chorioangioma, or when the placenta is anterior.…”

Section: Discussionmentioning

confidence: 99%

“…Its limitations include the need of two entry ports (fetoscope and bipolar forceps) and the difficulty in grasping the feeding vessel when it is closely adherent to the chorioangioma, or when the placenta is anterior. Radiofrequency ablation was used only for controlling bleeding from vessel rupture following failed bipolar or laser coagulation [5] . Ultrasound-guided interstitial laser to the chorioangioma had favourable outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-Guided Percutaneous Embolisation of Placental Chorioangioma Using Cyanoacrylate

Cheng¹,

Yu²,

So³

et al. 2016

Fetal Diagn Ther

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We describe a case of large chorioangioma diagnosed at 22 weeks of gestation. As the tumour progressively enlarged to 8 cm with fetal cardiomegaly and increased middle cerebral arterial peak systolic velocity, embolisation of its feeding artery by percutaneous injection of cyanoacrylate was performed under ultrasound guidance. Devascularisation was immediate and complete, and the fetal cardiomegaly and anaemic features resolved after 3 weeks. A healthy infant was born at 34 weeks of gestation following spontaneous preterm labour. Pathological examination of the placenta confirmed an infarcted chorioangioma. Literature on the various prenatal treatments of chorioangioma was reviewed and showed that embolisation using cyanoacrylate is a feasible, simple, and effective treatment for large chorioangiomas. The techniques to optimise the success of the procedure were also discussed.

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“…(21)(22)(23) RFA vascular ablation extends its utility to singleton pregnancies. (24)(25)(26) Before the introduction of RFA, MC twins discordant for fetal complications were not offered selective feticide at NUH.…”

Section: Introductionmentioning

confidence: 99%

Rapid initiation of fetal therapy services with a system of learner-centred training under proctorship: the National University Hospital (Singapore) experience

Gosavi

Vijayakumar

et al. 2017

smedj

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INTRODUCTION Management of complicated monochorionic twins and certain intrauterine structural anomalies is a pressing challenge in communities that still lack advanced fetal therapy. We describe our efforts to rapidly initiate selective feticide using radiofrequency ablation (RFA) and selective fetoscopic laser photocoagulation (SFLP) for twin-to-twin transfusion syndrome (TTTS), and present the latter as a potential model for aspiring fetal therapy units. METHODSFive pregnancies with fetal complications were identifi ed for RFA. Three pregnancies with Stage II TTTS were selected for SFLP. While RFA techniques utilising ultrasonography skills were quickly mastered, SFLP required stepwise technical learning with an overseas-based proctor, who provided real-time hands-off supervision.RESULTS All co-twins were live-born following selective feticide; one singleton pregnancy was lost. Fetoscopy techniques were learned in a stepwise manner and procedures were performed by a novice team of surgeons under proctorship. Dichorionisation was completed in only one patient. Five of six twins were live-born near term. One pregnancy developed twin anaemia-polycythaemia sequence, while another was complicated by co-twin demise.DISCUSSION Proctor-supervised directed learning facilitated the rapid provision of basic fetal therapy services by our unit. While traditional apprenticeship is important for building individual expertise, this system is complementary and may benefi t other small units committed to providing these services.

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Giant Chorioangiomas: Perinatal Outcomes and Techniques in Fetoscopic Devascularization

Cited by 32 publications

References 17 publications

Call for Caution: Neonatal Portal Vein Thrombosis following Enbucrilate Embolization of Placental Chorioangioma

Call for Caution: Neonatal Portal Vein Thrombosis following Enbucrilate Embolization of Placental Chorioangioma

Ultrasound-Guided Percutaneous Embolisation of Placental Chorioangioma Using Cyanoacrylate

Rapid initiation of fetal therapy services with a system of learner-centred training under proctorship: the National University Hospital (Singapore) experience

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