Minimally invasive fetal surgery for myelomeningocele: preliminary report from a single center

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Recent trials have shown the safety and benefits of fetoscopic treatment of myelomeningocele (MMC). The authors’ aim was to report their preliminary results of prenatal fetoscopic treatment of MMC using a biocellulose patch, focusing on neurological outcomes, fetal and maternal complications, neonatal CSF leakage, postnatal hydrocephalus, and radiological outcomes.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Preoperative assessment included clinical examination, ultrasound imaging, and MRI of the fetus. Patients underwent purely fetoscopic in utero MMC repair, followed by postoperative in utero and postnatal MRI. All participants received multidisciplinary follow-up.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Five pregnant women carrying fetuses affected by MMC signed informed consent for the fetoscopic treatment of the defect. The mean MMC size was 30.4 mm (range 19–49 mm). Defect locations were L1 (2 cases), L5 (2 cases), and L4 (1 case). Hindbrain herniation and ventriculomegaly were documented in all cases. The mean gestational age at surgery was 28.2 weeks (range 27.8–28.8 weeks). Fetoscopic repair was performed in all cases. The mean gestational age at delivery was 33.9 weeks (range 29.3–37.4 weeks). After surgery, reversal of hindbrain herniation was documented in all cases. Three newborns developed signs of hydrocephalus requiring CSF diversion. Neurological outcomes in terms of motor level were favorable in all cases, but a premature newborn died due to CSF infection and sepsis.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The authors’ preliminary results suggest that fetoscopic treatment of MMC is feasible, reproducible, and safe for mothers and their babies. Neurological outcomes were favorable and similar to those in the available literature. As known, prematurity was the greatest complication.</jats:p></jats:sec>

Therapeutic Approaches to Treat Mitochondrial Diseases: “One-Size-Fits-All” and “Precision Medicine” Strategies

“…Current prenatal genetic technology can diagnose rare genetic diseases as early as the 12th week of pregnancy by chorionic villous sampling or from the 16th week by amniocentesis. Advances in fetal imaging and minimally invasive surgical equipment have also led to the development of interventional techniques for prenatal treatment of several fetal structural defects, such as congenital diaphragmatic hernia, myelomeningocele, pulmonary sequestration, hydrothorax, urinary tract obstruction, fetal tumours and others [ 411 ]. Also, intrauterine access to the fetal circulation through the umbilical vein is a well-described procedure, used to perform ultrasound-guided fetal blood or platelet transfusions, which are currently the standard of care in cases of fetal anemia and thrombocytopenia [ 412 ].…”

Myelomeningocele Surgery over the 10 Years Following the MOMS Trial: A Systematic Review of Outcomes in Prenatal versus Postnatal Surgical Repair

“…The remaining 112 were assessed for eligibility by full-text reading. The selection left us with 27 eligible articles that were included in the study ( Figure 1 ) [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ].…”

Fetal blood gases after in utero carbon dioxide insufflation for percutaneous fetoscopic spina bifida repair

“…Percutaneous OSB repair was performed using surgical principles previously reported. 4,5,8,21 The key components have been described by Lapa et al, and are briefly described here. 6 Patients were placed under general anesthesia using techniques to minimize inhaled anesthetic agents (e.g., desflurane and sevoflurane), favoring the usage of intravenous anesthesia via a sedative and analgesic combination (e.g., propofol and remifentanil).…”

“…3 Given these aforementioned procedure-related risks of open maternal-fetal surgery, fetoscopic approaches to OSB repair have been developed. [4][5][6][7][8] Fetoscopic OSB repair techniques avoid hysterotomy, reduce maternal morbidity, and maintain the option for a vaginal delivery at term in the index and subsequent pregnancies. [4][5][6][7] Importantly, these techniques avoid the risk of preterm uterine rupture.…”

“…[4][5][6][7][8] Fetoscopic OSB repair techniques avoid hysterotomy, reduce maternal morbidity, and maintain the option for a vaginal delivery at term in the index and subsequent pregnancies. [4][5][6][7] Importantly, these techniques avoid the risk of preterm uterine rupture. 9 Unique to the fetoscopic approach for OSB repair is the requirement for intrauterine partial carbon dioxide (CO 2 ) insufflation (PACI).…”