Luc Joyeux1,2, Felix De Bie2, Enrico Danzer3,4, Tim Van Mieghem5, Alan W Flake3,4, Jan Deprest1,2,6,7. 1. Academic Department Development and Regeneration, Cluster Organ Systems, Biomedical Sciences, Faculty of Medicine, Katholieke Universiteit (KU) Leuven, Leuven, Belgium. 2. Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium. 3. Center for Fetal Diagnosis and Treatment, the Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 4. Department of Surgery, Children's Center for Fetal Research, Abramson Research center, the Children's Hospital of Philadelphia, Philadelphia, PA, USA. 5. Department of Obstetrics and Gynecology, Fetal Medicine Unit, Mt. Sinai Hospital, University of Toronto, Toronto, Canada. 6. Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospital Gasthuisberg UZ Leuven, Leuven, Belgium. 7. Institute of Women's Health, University College London Hospitals, London, UK.
Abstract
OBJECTIVE: To determine the safety and efficacy of different neurosurgical techniques for closure of spina bifida (SB) in the fetal lamb model. METHOD: Systematic review of studies reporting on fetal lambs undergoing induction and closure of SB compared with non-operated normal lambs (negative controls) and/or lambs not undergoing closure of the defect (positive controls). Primary outcomes were (1) survival at birth (safety) and/or (2) presence of Somatosensory Evoked Potentials on hind limbs and/or improvement in quantitative histological spinal cord findings and/or reversal of hindbrain herniation (efficacy). RESULTS: Out of 1311, 36 full-text articles were eligible. Nineteen were included for quality assessment. Due to high bias, only 2 adequately powered studies were included in the final analysis. An open approach using a 2-layer closure (muscle flap or acellular-dermal-matrix patch plus skin) was the only safe (patch + skin) and effective (both techniques) technique for prenatal closure in this animal model. No comparable level of evidence was identified for other techniques. CONCLUSION: The experimental literature on prenatal SB closure underscores the lack of standardization. At present, there is animal experimental evidence that a 2-layer closure by hysterotomy is safe and effective. This technique is currently clinically used in a subset of patients. As new clinical techniques are introduced, it would seem logic to preclinically validate them against this experimental standard.
OBJECTIVE: To determine the safety and efficacy of different neurosurgical techniques for closure of spina bifida (SB) in the fetal lamb model. METHOD: Systematic review of studies reporting on fetal lambs undergoing induction and closure of SB compared with non-operated normal lambs (negative controls) and/or lambs not undergoing closure of the defect (positive controls). Primary outcomes were (1) survival at birth (safety) and/or (2) presence of Somatosensory Evoked Potentials on hind limbs and/or improvement in quantitative histological spinal cord findings and/or reversal of hindbrain herniation (efficacy). RESULTS: Out of 1311, 36 full-text articles were eligible. Nineteen were included for quality assessment. Due to high bias, only 2 adequately powered studies were included in the final analysis. An open approach using a 2-layer closure (muscle flap or acellular-dermal-matrix patch plus skin) was the only safe (patch + skin) and effective (both techniques) technique for prenatal closure in this animal model. No comparable level of evidence was identified for other techniques. CONCLUSION: The experimental literature on prenatal SB closure underscores the lack of standardization. At present, there is animal experimental evidence that a 2-layer closure by hysterotomy is safe and effective. This technique is currently clinically used in a subset of patients. As new clinical techniques are introduced, it would seem logic to preclinically validate them against this experimental standard.
Authors: Luc Joyeux; Alexander C Engels; Johannes Van Der Merwe; Michael Aertsen; Premal A Patel; Marjolijn Deprez; Ahmad Khatoun; Savitree Pranpanus; Marina Gabriela Monteiro Carvalho Mori da Cunha; Stephanie De Vleeschauwer; Johanna Parra; Katerina Apelt; Myles Mc Laughlin; Frank Van Calenbergh; Enrico Radaelli; Jan Deprest Journal: Sci Rep Date: 2019-06-27 Impact factor: 4.379
Authors: Luc Joyeux; Allan Javaux; Mary P Eastwood; Felix R De Bie; Gert Van den Bergh; Rebecca S Degliuomini; Simen Vergote; Talita Micheletti; Geertje Callewaert; Sebastien Ourselin; Paolo De Coppi; Frank Van Calenbergh; Emmanuel Vander Poorten; Jan Deprest Journal: Sci Rep Date: 2021-03-17 Impact factor: 4.379
Authors: Adalina Sacco; Fred Ushakov; Dominic Thompson; Donald Peebles; Pranav Pandya; Paolo De Coppi; Ruwan Wimalasundera; George Attilakos; Anna Louise David; Jan Deprest Journal: Obstet Gynaecol Date: 2019-09-27