OC14.03: Fetoscopic repair of meningomyelocele: watertight duramater closure is not paramount for fetal repair when using a biocellulose graft
Year: 2015
Type: conference-abstract
Abstract: To evaluate the feasibility of fetoscopic antenatal correction of open spina bifida, using a simplified technique, that precludes direct duramater closure. Ten consecutive pregnancies underwent fetoscopic repair of fetal lumbosacral spina bifida before 28 weeks of pregnancy. Under general anesthesia and after insertion of 3 trocars and partial CO2 insufflation of the amniotic cavity, the neuroplacode was released and an overlying biocellulose patch was secured in place by the fetal skin that was closed in the midline using a continuous single-layer suture. No direct duramater closure was performed. Preoperative, postoperative and postnatal MRI were performed. Postnatal neurodevelopmental evaluation was performed before discharge and scheduled for 3, 6 and 12 months after birth. Fetoscopic repair was successful in 8/10 cases. One unrepaired fetus died in utero due to preeclampsia and the other was submitted to immediate postnatal repair. The median gestational age at birth was 32 weeks 3 days and the fetuses remained in utero for a mean of 5,6 weeks after surgery (range 2 to 8 weeks). One postnatal death occurred, leaving a total of 7 cases to be further analysed. Reversal of hindbrain herniation occurred in all 7 and the mean follow-up was 6,6 months (range 0 to 17 months). A ventriculoperitoneal shunt was required in 2/7 cases and one case was submitted to a third ventriculostomy. Functional motor level was equal to, or better than, the anatomical lesion level in 6/7 cases. There was no significant maternal morbidity. Fetoscopic repair of open spina bifida is feasible, resulting in improvement of motor function. The reversal of hindbrain herniation suggests primary duramater closure may not to be essential in prenatal repair and this represents an important shift of paradigm in the defect's correction. Further studies are required to confirm efficacy and safety.
DOI: 10.1002/uog.15039
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2198994348