Marcos M Miyabe1, Kendall P Murphy1,2, Marc Oria1,3,4, Soner Duru1, Chia-Ying Lin2, Jose L Peiro5,6,7. 1. Center for Fetal and Placental Research, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, USA. 2. Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA. 3. Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 4. Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA. 5. Center for Fetal and Placental Research, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, USA. jose.peiro@cchmc.org. 6. Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. jose.peiro@cchmc.org. 7. Department of Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA. jose.peiro@cchmc.org.
Abstract
PURPOSE: The use of materials to facilitate dural closure during spina bifida (SB) repair has been a highly studied aspect of the surgical procedure. The overall objective of this review is to present key findings pertaining to the success of the materials used in clinical and pre-clinical studies. Additionally, this review aims to aid fetal surgeons as they prepare for open or fetoscopic prenatal SB repairs. METHODS: Relevant publications centered on dural substitutes used during SB repair were identified. Important information from each article was extracted including year of publication, material class and sub-class, animal model used in pre-clinical studies, whether the repair was conducted pre-or postnatally, the bioactive agent delivered, and key findings from the study. RESULTS: Out of 1,121 publications, 71 were selected for full review. We identified the investigation of 33 different patches where 20 and 63 publications studied synthetic and natural materials, respectively. From this library, 43.6% focused on clinical results, 36.6% focused on pre-clinical results, and 19.8% focused on tissue engineering approaches. Overall, the use of patches, irrespective of material, have shown to successfully protect the spinal cord and most have shown promising survival and neurological outcomes. CONCLUSION: While most have shown significant promise as a therapeutic strategy in both clinical and pre-clinical studies, none of the patches developed so far are deemed perfect for SB repair. Therefore, there is an opportunity to develop new materials and strategies that aim to overcome these challenges and further improve the outcomes of SB patients.
PURPOSE: The use of materials to facilitate dural closure during spina bifida (SB) repair has been a highly studied aspect of the surgical procedure. The overall objective of this review is to present key findings pertaining to the success of the materials used in clinical and pre-clinical studies. Additionally, this review aims to aid fetal surgeons as they prepare for open or fetoscopic prenatal SB repairs. METHODS: Relevant publications centered on dural substitutes used during SB repair were identified. Important information from each article was extracted including year of publication, material class and sub-class, animal model used in pre-clinical studies, whether the repair was conducted pre-or postnatally, the bioactive agent delivered, and key findings from the study. RESULTS: Out of 1,121 publications, 71 were selected for full review. We identified the investigation of 33 different patches where 20 and 63 publications studied synthetic and natural materials, respectively. From this library, 43.6% focused on clinical results, 36.6% focused on pre-clinical results, and 19.8% focused on tissue engineering approaches. Overall, the use of patches, irrespective of material, have shown to successfully protect the spinal cord and most have shown promising survival and neurological outcomes. CONCLUSION: While most have shown significant promise as a therapeutic strategy in both clinical and pre-clinical studies, none of the patches developed so far are deemed perfect for SB repair. Therefore, there is an opportunity to develop new materials and strategies that aim to overcome these challenges and further improve the outcomes of SB patients.
Authors: Kelly A Bennett; Mary Anne Carroll; Chevis N Shannon; Stephane A Braun; Mary E Dabrowiak; Alicia K Crum; Ray L Paschall; Ann L Kavanaugh-McHugh; John C Wellons; Noel B Tulipan Journal: J Neurosurg Pediatr Date: 2014-05-02 Impact factor: 2.375
Authors: N Scott Adzick; Elizabeth A Thom; Catherine Y Spong; John W Brock; Pamela K Burrows; Mark P Johnson; Lori J Howell; Jody A Farrell; Mary E Dabrowiak; Leslie N Sutton; Nalin Gupta; Noel B Tulipan; Mary E D'Alton; Diana L Farmer Journal: N Engl J Med Date: 2011-02-09 Impact factor: 91.245
Authors: Thomas Kohl; Rudolph Hering; Axel Heep; Carlo Schaller; Bernhard Meyer; Claudia Greive; Gabriele Bizjak; Tim Buller; Patricia Van de Vondel; Wiebke Gogarten; Peter Bartmann; Gisela Knopfle; Ulrich Gembruch Journal: Fetal Diagn Ther Date: 2006 Impact factor: 2.587