In utero repair of experimental myelomeningocele saves neurological function at birth

Meuli, Martin; Meuli‐Simmen, Claudia; Yingling, Charles D.; Hutchins, Grover M.; Timmel, Gregory B.; Harrison, Michael R.; Adzick, N. Scott

doi:10.1016/s0022-3468(96)90746-0

Cited by 162 publications

(115 citation statements)

References 23 publications

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“…The simplified technique also allowed better preservation of the spinal cord cytoarchitecture. Several previous studies on the intrauterine correction of myelomeningocele had already suggested that prenatal correction led to a better preservation of the spinal cord and better clinical results (10)(11)(12)(13) .The MOMS study demonstrated that the intrauterine correction reduced the need of ventriculoperitoneal shunting from 82 to 40% comparing postnatal with prenatal correction, respectively. That study also showed better cognitive and motor skills up to 30 months of age in the group submitted to prenatal correction (6) .…”

Section: Discussionmentioning

confidence: 94%

Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep

Herrera

Leme

Valente

et al. 2012

Einstein (São Paulo)

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Objective: To compare the classical neurosurgical technique with a new simplified technique for prenatal repair of a myelomeningocelelike defect in sheep. Methods: A myelomeningocele-like defect (laminectomy and dural excision) was created in the lumbar region on day 90 of gestation in 9 pregnant sheep. Correction technique was randomized. In Group 1 the defect was corrected using the classic neurosurgical technique of three-layer suture (dura mater, muscle and skin closure) performed by a neurosurgeon. In Group 2, a fetal medicine specialist used a biosynthetic cellulose patch to protect the spinal cord and only the skin was sutured above it. Near term (day 132 of gestation) fetuses were sacrificed for pathological analysis. Results: There were two miscarriages and one maternal death. In total, six cases were available for pathological analysis, three in each group. In Group 1, there were adherence of the spinal cord to the scar (meningo-neural adhesion) and spinal cord architecture loss with posterior funiculus destruction and no visualization of grey matter. In Group 2, we observed in all cases formation of a neo-dura mater, separating the nervous tissue from adjacent muscles, and preserving the posterior funiculus and grey matter. Conclusion: The new simplified technique was better than the classic neurosurgical technique. It preserved the nervous tissue and prevented the adherence of the spinal cord to the scar. This suggests the current technique used for the correction of spina bifida in humans may need to be reassessed. de ovelhas. Métodos: Em 9 fetos, foi criado um defeito semelhante à mielomeningocele (laminectomia e excisão de dura-máter) no 90° dia de gestação. O tipo de correção foi randomizado. No Grupo 1, o defeito foi corrigido usando a técnica neurocirúrgica clássica, com a sutura de três camadas (dura-máter, músculo e pele), realizada por um neurocirurgião. No Grupo 2, um especialista em Medicina Fetal utilizou a técnica simplificada, colocando um fragmento de celulose biossintética sobre a medula e suturando apenas da pele sobre a celulose. Próximo ao termo da gestação (132 dias), os fetos foram sacrificados para análise anatomopatológica. Resultados: Ocorreram dois casos de aborto e uma morte materna, restando seis casos para avaliação -três em cada grupo. No Grupo 1, todos os casos mostraram aderência da medula à cicatriz (meningoadesão) e perda da arquitetura medular, com destruição do funículo posterior e perda da visualização da substância cinzenta. No Grupo 2, observou-se, em todos os casos, a formação de uma neodura-máter, separando o tecido nervoso do músculo adjacente, sendo que o funículo posterior e a substância cinzenta estavam preservados. Conclusão: A técnica simplificada foi superior à neurocirúrgica, com maior preservação da medula e evitando as aderências do tecido nervoso. Os presentes achados sugerem que a técnica utilizada atualmente na correção de mielomeningocele em fetos humanos deva ser reavaliada. Keywords

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Section: Discussionmentioning

confidence: 94%

Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep

Herrera

Leme

Valente

et al. 2012

Einstein (São Paulo)

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“…The standard large animal model used for such research is the fetal lamb model of MMC, which has been extensively characterized and shown to exhibit histologic and neurologic deficits comparable to those seen in congenital MMC in humans [2,5,6,8]. Despite decades of research using this model, a means of consistent functional assessment is lacking.…”

Section: Discussionmentioning

confidence: 99%

Development of a Locomotor Rating Scale for Testing Motor Function in Sheep

Brown

Keller

Pivetti

et al. 2015

Journal of Pediatric Surgery

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“…Although the exact etiology of MMC is unknown, studies of fetuses suggest that the spinal cord is relatively normal initially and becomes damaged as a secondary result of its exposure to amniotic fluid or some other intrauterine factor (32). In a lamb model, where a MMC type lesion was created early in gestation and then subsequently repaired, there was significantly less neurological deficits in the lambs that underwent in-utero repair (33). This concept was applied to the treatment of human fetuses with MMC, culminating in the landmark Management of Myelomeningocele Study (MOMS) trial.…”

Section: MMCmentioning

confidence: 99%

Advances in fetal surgery

Maselli¹,

Badillo²

2016

Ann. Transl. Med.

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Historically, the gold standard for the treatment of congenital malformations has been planned delivery at tertiary care center with attempted post-natal repair or amelioration of the lesion. Over the last few decades however, rapid advances in imaging and instrumentation technology combined with superior knowledge of fetal pathophysiology has led to the development of novel intrauterine interventions for most common fetal anomalies.Great success has already been seen the treatment of previous devastating anomalies such as myelomeningocele (MMC), congenital cystic malformations of the lung, twin-twin transfusion, and sacrococcygeal teratomas.Although still limited, these innovative techniques have unique potential to improve outcomes in the most devastating fetal anomalies.

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In utero repair of experimental myelomeningocele saves neurological function at birth

Cited by 162 publications

References 23 publications

Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep

Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep

Development of a Locomotor Rating Scale for Testing Motor Function in Sheep

Advances in fetal surgery

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