Two-Port Fetoscopic Repair of Myelomeningocele in Fetal Lambs

Guilbaud, Lucie; Roux, N.; Friszer, Stéphanie; Dhombres, Ferdinand; Vialle, Raphaël; Shah, Zoobia; Garabédian, Charles; Bessières, Bettina; Rocco, Federico Di; Zérah, Michel; Jouannic, Jean‐Marie

doi:10.1159/000485655

Cited by 12 publications

(9 citation statements)

References 15 publications

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“…It is important to highlight that uncomplicated vaginal deliveries were reported in minimally-invasive techniques, which opens the possibility of future studies evaluating the risks and benefits of vaginal delivery in appropriately selected patients as proposed by fetoscopic spine Bifida repair studies with exteriorization of the uterus. 10,27 In regards to neurological results, the reversal of the hindbrain and the decrease in the need for ventriculoperitoneal shunt placement is one of the greatest benefits associated with the prenatal intervention compared to postnatal correction. According to our analysis, these benefits were similar between the three open fetal surgery techniques.…”

Section: Regarding the Microneurosurgery Technique It Presented Lessmentioning

confidence: 99%

Open surgery for in utero repair of spina bifida: Microneurosurgery versus standard technique – A systematic review

et al. 2021

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Background/objectives: Prenatal myelomeningocele (MMC) repair has been shown to improve neurological outcomes. It has been suggested that decreases in the hysterotomy diameter during surgery can improve perinatal outcomes without altering neurologic outcomes. The objective of this study is to describe and compare the main maternal and fetal outcomes of fetuses undergoing open surgery for MMC repair, through the different modifications (standard-classical, mini-hysterotomy, and microneurosurgery).

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Section: Regarding the Microneurosurgery Technique It Presented Lessmentioning

confidence: 99%

Open surgery for in utero repair of spina bifida: Microneurosurgery versus standard technique – A systematic review

et al. 2021

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“…According to our local protocols, delivery is typically planned at 34 weeks' gestation in case of PROM. This French study provides additional data to preliminary reports of laparotomy-assisted fetoscopic repair performed in the USA and Spain [10,18,[26][27][28].…”

Section: Discussionmentioning

confidence: 71%

Laparotomy-Assisted 2-Port Fetoscopic Repair of Spina Bifida Aperta: Report of a Single-Center Experience in Paris, France

et al. 2022

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Background: Given the maternal morbidity of open fetal surgery, the development of prenatal fetoscopic repair for spina bifida aperta (SBA) is encouraged. Objective: We hereby report the early results from our center, using a laparotomy-assisted CO2-fetoscopic approach. Methods: This study was conducted in patients with an SBA<T1 and >S1, <26 weeks’ of gestation, with Chiari II. Fetoscopic repair was performed using 2 operating trocars in the uterus exteriorized through a transverse laparotomy. Endoscopy was performed under humidified and heated CO2 insufflation. Following dissection of the lesion, a 1-layer approach was performed with a muscle/skin flap sutured over a patch of Duragen. Main outcomes were watertight repair at birth and the need for postnatal neurosurgical surgery including shunting within 6 months. Results: Of 87 women assessed for prenatal therapy, 7 were included. Surgery was performed at 24 (23-26) weeks’ gestation. There was no fetal demise. Conversion to hysterotomy was not performed, although surgery could not be performed in one case because of fetal position. Severe preeclampsia developed postoperatively in one case. In the other 6 cases, follow-up was uneventful except for premature rupture membranes which occurred in 3/6 cases at 30, 34 and 36+5-weeks’ gestation. Gestational age at delivery was 32+5 (31-36+5) weeks’ gestation. Repair was watertight at birth except in two cases which required complementary postnatal surgical repair. Reverse hindbrain herniation during pregnancy was observed in 4/6 cases. In 3/6 cases, shunting was necessary within six months after birth. At 12 months, a functional gain >= 2 metameric levels, was observed in 3 cases of the 6 survivors Conclusion: Laparotomy-assisted fetoscopic repair is a reasonable option for women who choose and are eligible for antenatal surgery, both in terms of maternal and perinatal morbidity.

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“…[ 12 ] Fetal surgery has also advanced to putting a scope and is called fetoscopic repair of MMCs. [ 13 ] But the widely followed procedure is that of open postnatal repair as described by Pang. [ 14 ] The aim of surgical repair of MMC is to cover the exposed spinal cord and the nerve roots, to prevent CSF leaks, and to reduce the chances of central nervous system infection, which can occur due to defects created by surgery.…”

Section: Discussionmentioning

confidence: 99%

V-Y plasty or primary repair closure of myelomeningocele: Our experience

Lobo

Nayak

2018

J Pediatr Neurosci

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Background:Open neural tube defects in the spine most commonly are in the lumbo-sacral region. Surgical closure is the treatment, but in primary closure the chances of CSF leak are more. Hence a novel technique of using an advancement flap called the V-Y plasty for closure of these defects(6). Our study compares the outcomes of primary closure and V-Y plasty in the closure of Myelomeningocoeles.Methods:A prospective study of the infants who underwent surgical repair for MMC at our hospital from August 2014- January 2018 were included in the study. Total of 22 infants were treated, 9 underwent primary repair and 13 underwent V-Y plasty.Results:The time taken for primary closure was a mean of 120 min, while the advancement flap took longer of 190.7 min. All the 9 who underwent primary closure had CSF leak, 3 developed hydrocephalus, 6 had wound dehiscence, 3 had neurological deficits and 1 died. Of the 13 infants who underwent V-Y plasty 3 had CSF leaks, 1 had hydrocephalus, 5 had neurological deficits and no wound dehiscence or deaths.Conclusion:The aim of surgical repair is to cover the exposed neural tissue, prevent CSF leak and reduce CNS infections. V-Y plasty a plastic surgical technique of advancement flaps with intact pedicles improves the outcome of skin closure once the neural placode is placed in the dura and closed. This reduces the morbidity in a one-time procedure.

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Two-Port Fetoscopic Repair of Myelomeningocele in Fetal Lambs

Cited by 12 publications

References 15 publications

Open surgery for in utero repair of spina bifida: Microneurosurgery versus standard technique – A systematic review

Open surgery for in utero repair of spina bifida: Microneurosurgery versus standard technique – A systematic review

Laparotomy-Assisted 2-Port Fetoscopic Repair of Spina Bifida Aperta: Report of a Single-Center Experience in Paris, France

V-Y plasty or primary repair closure of myelomeningocele: Our experience

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