OBJECTIVE: To report our preliminary clinical experience in the antenatal correction of open spina bifida (OSB) using a fetoscopic approach and a simplified closure technique. METHODS: Four fetuses with lumbar-sacral defects were operated in utero from 25 to 27 weeks. Surgeries were performed percutaneously under general anesthesia using three trocars and partial carbon dioxide insufflation. After dissection of the neural placode, the surrounding skin was closed over a cellulose patch using a single continuous stitch. RESULTS: Surgical closure was successful in three of the four cases. All successful cases showed improvement of the hindbrain herniation and no neonatal neurosurgical repair was required in two cases. Delivery occurred between 31 and 33 weeks, and no fetal or neonatal deaths occurred. Ventriculoperitoneal shunting was not needed in two out of the 3 successful cases. CONCLUSIONS: Our preliminary experience suggests that definitive fetoscopic repair of OSB is feasible using our innovative surgical technique. A phase I trial for the fetoscopic correction of OSB with this technique is currently being conducted.
OBJECTIVE: To report our preliminary clinical experience in the antenatal correction of open spina bifida (OSB) using a fetoscopic approach and a simplified closure technique. METHODS: Four fetuses with lumbar-sacral defects were operated in utero from 25 to 27 weeks. Surgeries were performed percutaneously under general anesthesia using three trocars and partial carbon dioxide insufflation. After dissection of the neural placode, the surrounding skin was closed over a cellulose patch using a single continuous stitch. RESULTS: Surgical closure was successful in three of the four cases. All successful cases showed improvement of the hindbrain herniation and no neonatal neurosurgical repair was required in two cases. Delivery occurred between 31 and 33 weeks, and no fetal or neonatal deaths occurred. Ventriculoperitoneal shunting was not needed in two out of the 3 successful cases. CONCLUSIONS: Our preliminary experience suggests that definitive fetoscopic repair of OSB is feasible using our innovative surgical technique. A phase I trial for the fetoscopic correction of OSB with this technique is currently being conducted.
Authors: Elke Januschek; Andreas Röhrig; Sandra Kunze; Christian Fremerey; Bea Wiebe; Martina Messing-Jünger Journal: Childs Nerv Syst Date: 2016-04-16 Impact factor: 1.475
Authors: Sandra K Kabagambe; Y Julia Chen; Melissa A Vanover; Payam Saadai; Diana L Farmer Journal: Childs Nerv Syst Date: 2017-05-11 Impact factor: 1.475
Authors: Adalina Sacco; Lennart Van der Veeken; Emma Bagshaw; Catherine Ferguson; Tim Van Mieghem; Anna L David; Jan Deprest Journal: Prenat Diagn Date: 2019-02-27 Impact factor: 3.050