Proceedings of the First Annual Meeting of the International Fetoscopic Myelomeningocele Repair Consortium

Cortes, M. Sanz; Lapa, D.A.; Acácio, Gregório Lorenzo; Belfort, Michael A.; Carreras, Elena; Maíz, Nerea; Peiró, José L.; Lim, Foong‐Yen; Miller, Jena L.; Baschat, Ahmet; Sepúlveda, Gerardo; Davila, I.; Gielchinsky, Yuval; Benifla, Mony; Stirnemann, J.; Ville, Y.; Yamamoto, M.; Figueroa, H.; Simpson, Lynn L.; Nicolaides, Kypros H.

doi:10.1002/uog.20308

Cited by 42 publications

(69 citation statements)

References 17 publications

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“…Minimally invasive approaches to repair fetal MMC have been implemented in different centers [7][8][9][10][11][12][13][14][15][16][17][18] to decrease obstetric and perinatal morbidity, while preserving the improved infant outcomes. In our experience, the main advantages of the exteriorized-uterus two-port fetoscopic approach 7 , used in our center, are the decreased incidence of maternal complications, the possibility of vaginal delivery 19 and a higher gestational age (GA) at birth than that seen when using the open-hysterotomy approach.…”

Section: Introductionmentioning

confidence: 99%

Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy‐assisted fetoscopic or open approach

Sanz‐Cortes

Torres

Yepez

et al. 2020

Ultrasound in Obstet & Gyne

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CONTRIBUTIONWhat are the novel findings of this work? Prenatal and postnatal brain microstructure is similar between infants who underwent open hysterotomy and those who had fetoscopic spina bifida repair, and changes seen over time were also comparable between the two groups. These findings support the safety of using CO 2 gas for uterine insufflation during fetoscopic spina bifida repair. What are the clinical implications of this work?The findings of this study add to the body of evidence supporting the use of CO 2 for uterine insufflation in fetoscopic myelomeningocele repair. Fetoscopic techniques are safer for the mother and the fetus than is open repair. As a shift in practice towards fetoscopic repair is expected, evidence for the safety of CO 2 use is of critical relevance. ABSTRACTObjective To compare prenatal and postnatal brain microstructure between infants that underwent fetoscopic myelomeningocele (MMC) repair and those that had open-hysterotomy repair. Methods This was a longitudinal retrospective cohort study of 57 fetuses that met the Management of Myelomeningocele Study (MOMS) trial criteria and underwent prenatal MMC repair, by a fetoscopic (n = 27) or open-hysterotomy (n = 30) approach, atResults There were no differences in GA at surgery or GA/postnatal age at MRI between the groups. No significant differences were observed in ADC values in any of the brain areas assessed between the open-repair and fetoscopic-repair groups at 6 weeks after surgery and in the first year after birth. No differences were detected in the ADC values of the studied areas between the control 88 Sanz Cortes et al. and prenatally repaired groups, except for significantly increased ADC values in the genu of the corpus callosum in the open-hysterotomy and fetoscopic-repair groups. Additionally, there were no differences between the two prenatally repaired groups in the percentage change in ADC values at any of the time intervals analyzed. ConclusionsFetoscopic MMC repair has no detectable effect on brain microstructure when compared to babies repaired using an open-hysterotomy technique. CO 2 insufflation of the uterine cavity during fetoscopy does not seem to have any isolated deleterious effects on fetal brain microstructure.

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Section: Introductionmentioning

confidence: 99%

Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy‐assisted fetoscopic or open approach

Sanz‐Cortes

Torres

Yepez

et al. 2020

Ultrasound in Obstet & Gyne

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“…30,82 Continued advances in the evaluation of these biomaterials may eventually enable more widespread adoption of fetoscopic repair of MMC defects, which remains technically demanding compared to open surgery but has been shown to induce less maternal-fetal morbidity. 83,84 Moving forward, we propose that our slice culture model could be used as a unique "disease-in-dish" approach to understand mechanisms of mechanical and chemical spinal cord injury in MMC. The direct and paracrine effects of neural stem cells on the fetal spinal cord remain essentially unknown, 47 and techniques for long-term experiments using spinal cord slice cultures have only recently been described.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hydrogel and neural progenitor cell delivery supports organotypic fetal spinal cord development in an ex vivo model of prenatal spina bifida repair

et al. 2020

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Studying how the fetal spinal cord regenerates in an ex vivo model of spina bifida repair may provide insights into the development of new tissue engineering treatment strategies to better optimize neurologic function in affected patients. Here, we developed hydrogel surgical patches designed for prenatal repair of myelomeningocele defects and demonstrated viability of both human and rat neural progenitor donor cells within this three-dimensional scaffold microenvironment. We then established an organotypic slice culture model using transverse lumbar spinal cord slices harvested from retinoic acid–exposed fetal rats to study the effect of fibrin hydrogel patches ex vivo. Based on histology, immunohistochemistry, gene expression, and enzyme-linked immunoabsorbent assays, these experiments demonstrate the biocompatibility of fibrin hydrogel patches on the fetal spinal cord and suggest this organotypic slice culture system as a useful platform for evaluating mechanisms of damage and repair in children with neural tube defects.

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“…80,84 Although some centers have deviated a bit from the In an attempt to decrease the risk of these complications, some centers have started to explore fetoscopic closure of the defect. [85][86][87] Fetoscopy may involve laparotomy while utilizing small holes in the uterus for access to the fetal spine thus avoiding hysterotomy. Some cases also use a percutaneous entry method.…”

Section: Ambulation Motor and Sensory Functionmentioning

confidence: 99%

Fetal spina bifida: What we tell the parents

et al. 2020

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Worldwide, about 150 000 infants are born with spina bifida yearly, making this condition one of the most common fetal central nervous system anomalies compatible with life. Over the last decade, major changes have been introduced in the prenatal diagnosis and management of spina bifida. In this review, we provide a brief summary of the current management of fetal spina bifida and present essential information that should be provided to expecting parents when their fetus has been diagnosed with spina bifida. This information is focused around common parental questions, as encountered in our typical clinical practice, to facilitate knowledge translation.

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Proceedings of the First Annual Meeting of the International Fetoscopic Myelomeningocele Repair Consortium

Cited by 42 publications

References 17 publications

Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy‐assisted fetoscopic or open approach

Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy‐assisted fetoscopic or open approach

Hydrogel and neural progenitor cell delivery supports organotypic fetal spinal cord development in an ex vivo model of prenatal spina bifida repair

Fetal spina bifida: What we tell the parents

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