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Stewart A, Hale AT, Saccomano BW, Barkley AS, Hopson BD, Arynchyna-Smith A, Johnston JM, Rocque BG, Blount JP, Rozzelle CJ. Neurosurgical management of Myelomeningocele in premature infants: a case series. Childs Nerv Syst 2024:10.1007/s00381-024-06524-3. [PMID: 39030337 DOI: 10.1007/s00381-024-06524-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 06/26/2024] [Indexed: 07/21/2024]
Abstract
INTRODUCTION Myelomeningocele (MMC) is the most common neural tube defect, but rarely seen in premature infants. Most centers advocate for closure of MMC within 24 h of birth. However, this is not always possible in severely premature infants. Given the rarity of this patient population, we aimed to share our institutional experience and outcomes of severely premature infants with MMC. METHODS We performed a retrospective, observational review of premature infants (≤ 32 weeks gestational age) identified through our multidisciplinary spina bifida clinic (1995-2021) and surgical logs. Descriptive statistics were compiled about this sample including timing of MMC closure and incidence of adverse events such as sepsis, CSF diversion, meningitis, and death. RESULTS Eight patients were identified (50% male) with MMC who were born ≤ 32 weeks gestational age. Mean gestational age of the population was 27.3 weeks (SD 3.5). Median time to MMC closure was 1.5 days (IQR = 1-80.8). Five patients were taken for surgery within the recommended 48 h of birth; 2 patients underwent significantly delayed closure (107 and 139 days); and one patient's defect epithelized without surgical intervention. Six of eight patients required permanent cerebrospinal fluid (CSF) diversion (2 patients were treated with ventriculoperitoneal shunting (VPS), three were treated with endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) and 1 patient treated with ETV; mean of 3 years after birth, ranging from 1 day to 16 years). Two patients required more than one permanent CSF diversion procedure. Two patients developed sepsis (defined as meeting at least 2/4 SIRS criteria). In both cases of sepsis, patients developed signs and symptoms more than 72 h after birth. Notably, both instances of sepsis occurred unrelated to operative intervention as they occurred before permanent MMC closure. Two patients had intraventricular hemorrhage (both grade III). No patients developed meningitis (defined as positive CSF cultures) prior to MMC closure. Median follow up duration was 9.7 years. During this time epoch, 3 patients died: Two before 2 years of age of causes unrelated to surgical intervention. One of the two patients with grade III IVH died within 24 h of MMC closure. CONCLUSIONS In our institutional experience with premature infants with MMC, some patients underwent delayed MMC closure. The overall rate of meningitis, sepsis, and mortality for preterm children with MMC was similar to MMC patients born at term.
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Affiliation(s)
- Addison Stewart
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Andrew T Hale
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | | | - Ariana S Barkley
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Betsy D Hopson
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | | | - James M Johnston
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Brandon G Rocque
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Jeffrey P Blount
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Curtis J Rozzelle
- Division of Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA.
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Andrade Santos S, Souza Nani F, Imaeda de Moura E, Lima de Carvalho D, Jorge Mattos Miguel G, Maria Federicci Haddad C, Edson Vieira J, Bunduki V, Henrique Burlacchini de Carvalho M, Pulcineli Vieira Francisco R, Dante Cardeal D, Dos Santos Fernandes H. Comparison of terbutaline and atosiban as tocolytic agents in intrauterine repair of myelomeningocele: a retrospective cohort study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:844495. [PMID: 38521500 PMCID: PMC10992278 DOI: 10.1016/j.bjane.2024.844495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/25/2024] [Accepted: 03/04/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Myelomeningocele (MMC) is a neural tube defect disease. Antenatal repair of fetal MMC is an alternative to postnatal repair. Many agents can be used as tocolytics during the in utero fetal repair such as β2-agonists and oxytocin receptor antagonists, with possible maternal and fetal repercussions. This study aims to compare maternal arterial blood gas analysis between terbutaline or atosiban, as tocolytic agents, during intrauterine MMC repair. METHODS Retrospective cohort study. Patients were divided into two groups depending on the main tocolytic agent used during intrauterine MMC repair: atosiban (16) or terbutaline (9). Maternal arterial blood gas samples were analyzed on three moments: post induction (baseline, before the start of tocolysis), before extubation, and two hours after the end of the surgery. RESULTS Twenty-five patients were included and assessed. Before extubation, the terbutaline group showed lower arterial pH (7.347 ± 0.05 vs. 7.396 ± 0.02 for atosiban, p = 0.006) and higher arterial lactate (28.33 ± 12.76 mg.dL-1 vs. 13.06 ± 6.35 mg.dL-1, for atosiban, p = 0.001) levels. CONCLUSIONS Patients who received terbutaline had more acidosis and higher levels of lactate, compared to those who received atosiban, during intrauterine fetal MMC repair.
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Affiliation(s)
- Shirley Andrade Santos
- University of Toronto, Mount Sinai Hospital, Department of Anesthesia and Pain Management, Toronto, Canada; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Fernando Souza Nani
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Elaine Imaeda de Moura
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Diogo Lima de Carvalho
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Guilherme Jorge Mattos Miguel
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Cristiane Maria Federicci Haddad
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Joaquim Edson Vieira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Anestesiologia, São Paulo, SP, Brazil
| | - Victor Bunduki
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, São Paulo, SP, Brazil
| | | | - Rossana Pulcineli Vieira Francisco
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, São Paulo, SP, Brazil
| | - Daniel Dante Cardeal
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Neurologia, São Paulo, SP, Brazil
| | - Hermann Dos Santos Fernandes
- University of Toronto, Mount Sinai Hospital, Department of Anesthesia and Pain Management, Toronto, Canada; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Anestesiologia, São Paulo, SP, Brazil.
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Stewart A, Hale AT, Saccomano BW, Barkley AS, Hopson BD, Arynchyna-Smith A, Johnston JM, Rocque BG, Blount JP, Rozzelle CJ. Neurosurgical Management of Myelomeningocele in Premature Infants: A Case Series. RESEARCH SQUARE 2024:rs.3.rs-4158288. [PMID: 38645257 PMCID: PMC11030521 DOI: 10.21203/rs.3.rs-4158288/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Introduction Myelomeningocele (MMC) is the most common neural tube defect, but rarely seen in premature infants. Most centers advocate for closure of MMC within 24 hours of birth. However, this is not always possible in severely premature infants. Given the rarity of this patient population, we aimed to share our institutional experience and outcomes of severely premature infants with MMC. Methods We performed a retrospective, observational review of premature infants (≤ 32 weeks gestational age) identified through our multidisciplinary spina bifida clinic (1995-2021) and surgical logs. Descriptive statistics were compiled about this sample including timing of MMC closure and incidence of adverse events such as sepsis, CSF diversion, meningitis, and death. Results Eight patients were identified (50% male) with MMC who were born ≤ 32 weeks gestational age. Mean gestational age of the population was 27.3 weeks (SD 3.5). Median time to MMC closure was 1.5 days (IQR = 1 -80.8). Five patients were taken for surgery within the recommended 48 hours of birth; 2 patients underwent significantly delayed closure (107 and 139 days); and one patient's defect epithelized without surgical intervention. Six of eight patients required permanent cerebrospinal fluid (CSF) diversion (2 patients were treated with ventriculoperitoneal shunting (VPS), three were treated with endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) and 1 patient treated with ETV; mean of 3 years after birth, ranging from 1 day to 16 years). Two patients required more than one permanent CSF diversion procedure. Two patients developed sepsis (defined as meeting at least 2/4 SIRS criteria), and 2 patients had intraventricular hemorrhage (both grade III). No patients developed meningitis (defined as positive CSF cultures) prior to MMC closure. Median follow up duration was 9.7 years. During this time epoch, 3 patients died: Two before 2 years of age of causes unrelated to surgical intervention. One of the two patients with grade III IVH died within 24 hours of MMC closure. Conclusions In our institutional experience with premature infants with MMC, some patients underwent delayed MMC closure. The overall rate of meningitis, sepsis, and mortality for preterm children with MMC was similar to MMC patients born at term.
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Pontell ME, Yengo-Kahn AM, Taylor E, Kane M, Newton JM, Bennett KA, Wellons JC, Braun SA. Intrauterine closure of myelomeningocele defects with primary linear repair versus bipedicle fasciocutaneous flaps: a post-MOMS cohort study with long-term follow-up. J Neurosurg Pediatr 2023; 31:143-150. [PMID: 36433869 DOI: 10.3171/2022.10.peds22357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/21/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine the effects of in utero bipedicle flaps on maternal-fetal morbidity/mortality, the need for CSF diversion, and long-term functional outcomes. METHODS Eighty-six patients who underwent fetal myelomeningocele repair from 2011 to 2021 at a single institution were reviewed. Primary outcomes included intrauterine fetal demise, postnatal death, postnatal myelomeningocele repair dehiscence, and CSF diversion by final follow-up. RESULTS The cohorts were no different with regard to race, ethnicity, maternal age at fetal surgery, body mass index, gravidity, parity, gestational age at fetal surgery, estimated fetal weight at fetal surgery, or fetal lesion level. Of the 86 patients, 64 underwent primary linear repair and 22 underwent bipedicle flap repair. There were no significant differences in rates of intrauterine fetal demise, postnatal mortality, midline repair site dehiscence, or the need for CSF diversion by final follow-up. Operative times were longer (32.5 vs 18.7 minutes, p < 0.001) and gestational age at delivery was lower (232 vs 241 days, p = 0.01) in the bipedicle flap cohort, but long-term functional outcomes were not different. CONCLUSIONS Analysis of the total cohort affirms the long-term benefits of fetal myelomeningocele repair. In utero bipedicle flaps are safe and can be used for high-tension lesions without increasing perioperative risks to the mother or fetus. In utero flaps preserve the long-term benefits seen with primary linear repair and may expand inclusion criteria for fetal repair, providing life-changing care for more patients.
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Affiliation(s)
| | | | - Emily Taylor
- 3The Fetal Center at Vanderbilt, Vanderbilt University Medical Center, Nashville
| | - Morgan Kane
- 4Pediatric Rehabilitation Services, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
| | - J Michael Newton
- 3The Fetal Center at Vanderbilt, Vanderbilt University Medical Center, Nashville
- 5Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville
| | - Kelly A Bennett
- 3The Fetal Center at Vanderbilt, Vanderbilt University Medical Center, Nashville
- 5Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville
| | - John C Wellons
- 1Departments of Plastic Surgery
- 3The Fetal Center at Vanderbilt, Vanderbilt University Medical Center, Nashville
- 6The Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville; and
- 7Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Stephane A Braun
- 1Departments of Plastic Surgery
- 3The Fetal Center at Vanderbilt, Vanderbilt University Medical Center, Nashville
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Abstract
Open-uterine surgery to repair spina bifida, or 'fetal surgery of open neural tube defects,' has generated questions throughout its history-and continues to do so in a variety of contexts. As clinical ethics consultants who worked (Mark J. Bliton) and trained (Virginia L. Bartlett) at Vanderbilt University-where the first successful cases of open-uterine repair of spina bifida were carried out-we lived with these questions for nearly two decades. We worked with clinicians as they were developing and offering the procedure, with researchers in refining and studying the procedure, and with pregnant women and their partners as they considered whether to undergo the procedure. From this experience in the early studies at Vanderbilt, we learned that pregnant women and their partners approach the clinical uncertainty of such a risky procedure with a curious and unique combination of practicality, self-reflection, fear, and overwhelming hope. These early experiences were a major contributing factor to the inclusion of an ethics-focused interview in the informed consent process for the Management of Myelomeningocele Study (MOMS) trial study design.
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Gadjradj PS, Spoor JKH, Eggink AJ, Wijnen R, Miller JL, Rosner M, Groves ML, DeKoninck PLJ, Harhangi BS, Baschat A, van Veelen ML, de Jong THR. Neurosurgeons' opinions on the prenatal management of myelomeningocele. Neurosurg Focus 2020; 47:E10. [PMID: 31574464 DOI: 10.3171/2019.7.focus19362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Improvements in imaging and surgical technological innovations have led to the increasing implementation of fetal surgical techniques. Open fetal surgery has demonstrated more favorable clinical outcomes in children born with open myelomeningocele (MMC) than those following postnatal repair. However, primarily because of maternal risks but also because of fetal risks, fetal surgery for MMC remains controversial. Here, the authors evaluated the contemporary management of MMC in the hope of identifying barriers and facilitators for neurosurgeons in providing fetal surgery for MMC. METHODS An online survey was emailed to members of the Congress of Neurological Surgeons (CNS) and the International Society for Pediatric Neurosurgery (ISPN) in March 2019. The survey focused on 1) characteristics of the respondents, 2) the practice of counseling on and managing prenatally diagnosed MMC, and 3) barriers, facilitators, and expectations of fetal surgery for MMC. Reminders were sent to improve the response rate. RESULTS A total of 446 respondents filled out the survey, most (59.2%) of whom specialized in pediatric neurosurgery. The respondents repaired an average of 9.6 MMC defects per year, regardless of technique. Regardless of the departments in which respondents were employed, 91.0% provided postnatal repair of MMC, 13.0% open fetal repair, and 4.9% fetoscopic repair. According to the surgeons, the most important objections to performing open fetal surgery were a lack of cases available to become proficient in the technique (33.8%), the risk of maternal complications (23.6%), and concern for fetal complications (15.2%). The most important facilitators according to advocates of prenatal closure are a decreased rate of shunt dependency (37.8%), a decreased rate of hindbrain herniation (27.0%), and an improved rate of motor function (18.9%). Of the respondents, only 16.9% agreed that open fetal surgery should be the standard of care. CONCLUSIONS The survey results showed diversity in the management of patients with MMC. In addition, significant diversity remains regarding fetal surgery for MMC closure. Despite the apparent benefits of open fetal surgery in selected pregnancies, only a minority of centers and providers offer this technique. As a more technically demanding technique that requires multidisciplinary effort with less well-established long-term outcomes, fetoscopic surgery may face similar limited implementation, although the surgery may pose fewer maternal risks than open fetal surgery. Centralization of prenatal treatment to tertiary care referral centers, as well as the use of sophisticated training models, may help to augment the most commonly cited objection to the implementation of prenatal closure, which is the overall limited caseload.
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Affiliation(s)
| | - Jochem K H Spoor
- 2Department of Neurosurgery, Erasmus University Medical Center Rotterdam
| | - Alex J Eggink
- 3Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine, Erasmus University Medical Center Rotterdam
| | - René Wijnen
- 4Department of Pediatric Surgery, Erasmus University Medical Center Rotterdam, The Netherlands; and Departments of
| | | | | | - Mari L Groves
- 6Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Philip L J DeKoninck
- 3Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine, Erasmus University Medical Center Rotterdam
| | | | | | | | - Tjeerd H R de Jong
- 2Department of Neurosurgery, Erasmus University Medical Center Rotterdam
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Koch KA, Reuner G, Beedgen B, Elsässer ML, Rom J, Fluhr H, Kölker S, Pöschl J, Sohn C, Unterberg A, Bächli H. Intrauterine Deckung von Myelomeningozelen. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-019-0736-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Oostendorp C, Geutjes PJ, Smit F, Tiemessen DM, Polman S, Abbawi A, Brouwer KM, Eggink AJ, Feitz WFJ, Daamen WF, van Kuppevelt TH. Sustained Postnatal Skin Regeneration Upon Prenatal Application of Functionalized Collagen Scaffolds. Tissue Eng Part A 2020; 27:10-25. [PMID: 31971880 DOI: 10.1089/ten.tea.2019.0234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Primary closure of fetal skin in spina bifida protects the spinal cord and improves clinical outcome, but is also associated with postnatal growth malformations and spinal cord tethering. In this study, we evaluated the postnatal effects of prenatally closed full-thickness skin defects in sheep applying collagen scaffolds with and without heparin/vascular endothelial growth factor/fibroblast growth factor 2, focusing on skin regeneration and growth. At 6 months, collagen scaffold functionalized with heparin, VEGF, and FGF2 (COL-HEP/GF) resulted in a 6.9-fold increase of the surface area of the regenerated skin opposed to 1.7 × for collagen only. Epidermal thickness increased 5.7-fold at 1 month, in line with high gene expression of S100 proteins, and decreased to 2.1 at 6 months. Increased adipose tissue and reduced scaffold degradation and number of myofibroblasts were observed for COL-HEP/GF. Gene ontology terms related to extracellular matrix (ECM) organization were enriched for both scaffold treatments. In COL-HEP/GF, ECM gene expression resembled native skin. Expression of hair follicle-related genes in COL-HEP/GF was comparable to native skin, and de novo hair follicle generation was indicated. In conclusion, in utero closure of skin defects using functionalized collagen scaffolds resulted in long-term skin regeneration and growth. Functionalized collagen scaffolds that grow with the child may be useful for prenatal treatment of closure defects like spina bifida. Impact statement Prenatal closure of fetal skin in case of spina bifida prevents damage to the spinal cord. Closure of the defect is challenging and may result in postnatal growth malformations. In this study, the postnatal effects of a prenatally applied collagen scaffold functionalized with heparin and vascular endothelial growth factor (VEGF)/fibroblast growth factor (FGF) were investigated. An increase of the surface area of regenerated skin ("growing with the child") and generation of hair follicles was observed. Gene expression levels resembled those of native skin with respect to the extracellular matrix and hair follicles. Overall, in utero closure of skin defects using heparin/VEGF/FGF functionalized collagen scaffolds results in long-term skin regeneration.
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Affiliation(s)
- Corien Oostendorp
- Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul J Geutjes
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Dorien M Tiemessen
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sjoerd Polman
- Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aya Abbawi
- Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katrien M Brouwer
- Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alex J Eggink
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Wout F J Feitz
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willeke F Daamen
- Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Toin H van Kuppevelt
- Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Morphometric Features of the Latissimus Dorsi Muscle in Fetal Cadavers With Meningomyelocele for Prenatal Surgery. J Craniofac Surg 2020; 30:2628-2631. [PMID: 31369512 DOI: 10.1097/scs.0000000000005783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Latissimus dorsi (LD) flaps are frequently used in the prenatal meningomyelocele (MMC) repairs; on that basis, this study aims to reveal the morphometric features of LD, thoracodorsal artery (TDA) and nerve (TDN) in fetal cadavers with MMC defects, with an anatomical perspective. METHODS The study was conducted on 7 formalin-fixed human fetal cadavers (4 males and 3 females) with MMC defects, aged from 18 to 27 weeks of gestation. The size of LD, TDA, and TDN including their area, length, and width were measured by a digital caliper and digital image analysis software. Our direct measurements were compared with the corresponding estimations of a previous study in the literature which provides regression formulae based on gestational age. RESULTS The fetal cadavers with MMC had bilateral LD. No significant differences were found in the numerical data of anatomical structures between the sides or the sexes. LD size (ie, area, length and width) was approximately 3% to 10% smaller in the fetuses with MMC defects than that of the normal fetuses. Unilateral LD flap in a 22-week-old fetus with a large MMC was evaluated as insufficient to close the defects. CONCLUSION Ten percent shrinkage in the area of LD might be too critical to be disregarded by surgeons during the closure of MMC defects. The dimensional findings about LD (area, length, and width) may be helpful in planning of LD flap harvesting for the repairs of MMC.
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Extracellular Vesicles as a Potential Therapy for Neonatal Conditions: State of the Art and Challenges in Clinical Translation. Pharmaceutics 2019; 11:pharmaceutics11080404. [PMID: 31405234 PMCID: PMC6723449 DOI: 10.3390/pharmaceutics11080404] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/27/2019] [Accepted: 07/31/2019] [Indexed: 12/15/2022] Open
Abstract
Despite advances in intensive care, several neonatal conditions typically due to prematurity affect vital organs and are associated with high mortality and long-term morbidities. Current treatment strategies for these babies are only partially successful or are effective only in selected patients. Regenerative medicine has been shown to be a promising option for these conditions at an experimental level, but still warrants further exploration for the development of optimal treatment. Although stem cell-based therapy has emerged as a treatment option, studies have shown that it is associated with potential risks and hazards, especially in the fragile population of babies. Recently, extracellular vesicles (EVs) have emerged as an attractive therapeutic alternative that holds great regenerative potential and is cell-free. EVs are nanosized particles endogenously produced by cells that mediate intercellular communication through the transfer of their cargo. Currently, EVs are garnering considerable attention as they are the key effectors of stem cell paracrine signaling and can epigenetically regulate target cell genes through the release of RNA species, such as microRNA. Herein, we review the emerging literature on the therapeutic potential of EVs derived from different sources for the treatment of neonatal conditions that affect the brain, retinas, spine, lungs, and intestines and discuss the challenges for the translation of EVs into clinical practice.
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Torrents-Barrena J, Piella G, Masoller N, Gratacós E, Eixarch E, Ceresa M, Ballester MÁG. Segmentation and classification in MRI and US fetal imaging: Recent trends and future prospects. Med Image Anal 2018; 51:61-88. [PMID: 30390513 DOI: 10.1016/j.media.2018.10.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 10/09/2018] [Accepted: 10/18/2018] [Indexed: 12/19/2022]
Abstract
Fetal imaging is a burgeoning topic. New advancements in both magnetic resonance imaging and (3D) ultrasound currently allow doctors to diagnose fetal structural abnormalities such as those involved in twin-to-twin transfusion syndrome, gestational diabetes mellitus, pulmonary sequestration and hypoplasia, congenital heart disease, diaphragmatic hernia, ventriculomegaly, etc. Considering the continued breakthroughs in utero image analysis and (3D) reconstruction models, it is now possible to gain more insight into the ongoing development of the fetus. Best prenatal diagnosis performances rely on the conscious preparation of the clinicians in terms of fetal anatomy knowledge. Therefore, fetal imaging will likely span and increase its prevalence in the forthcoming years. This review covers state-of-the-art segmentation and classification methodologies for the whole fetus and, more specifically, the fetal brain, lungs, liver, heart and placenta in magnetic resonance imaging and (3D) ultrasound for the first time. Potential applications of the aforementioned methods into clinical settings are also inspected. Finally, improvements in existing approaches as well as most promising avenues to new areas of research are briefly outlined.
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Affiliation(s)
- Jordina Torrents-Barrena
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Gemma Piella
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Narcís Masoller
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Eduard Gratacós
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Elisenda Eixarch
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain; Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - Mario Ceresa
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Miguel Ángel González Ballester
- BCN MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain; ICREA, Barcelona, Spain
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Khan MSI, Nabeka H, Islam F, Shimokawa T, Saito S, Li X, Kawabe S, Hamada F, Tachibana T, Matsuda S. Early neonatal loss of inhibitory synaptic input to the spinal motor neurons confers spina bifida-like leg dysfunction in a chicken model. Dis Model Mech 2017; 10:1421-1432. [PMID: 28982681 PMCID: PMC5769610 DOI: 10.1242/dmm.031054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/02/2017] [Indexed: 01/03/2023] Open
Abstract
Spina bifida aperta (SBA), one of the most common congenital malformations, causes lifelong neurological complications, particularly in terms of motor dysfunction. Fetuses with SBA exhibit voluntary leg movements in utero and during early neonatal life, but these disappear within the first few weeks after birth. However, the pathophysiological sequence underlying such motor dysfunction remains unclear. Additionally, because important insights have yet to be obtained from human cases, an appropriate animal model is essential. Here, we investigated the neuropathological mechanisms of progression of SBA-like motor dysfunctions in a neural tube surgery-induced chicken model of SBA at different pathogenesis points ranging from embryonic to posthatch ages. We found that chicks with SBA-like features lose voluntary leg movements and subsequently exhibit lower-limb paralysis within the first 2 weeks after hatching, coinciding with the synaptic change-induced disruption of spinal motor networks at the site of the SBA lesion in the lumbosacral region. Such synaptic changes reduced the ratio of inhibitory-to-excitatory inputs to motor neurons and were associated with a drastic loss of γ-aminobutyric acid (GABA)ergic inputs and upregulation of the cholinergic activities of motor neurons. Furthermore, most of the neurons in ventral horns, which appeared to be suffering from excitotoxicity during the early postnatal days, underwent apoptosis. However, the triggers of cellular abnormalization and neurodegenerative signaling were evident in the middle- to late-gestational stages, probably attributable to the amniotic fluid-induced in ovo milieu. In conclusion, we found that early neonatal loss of neurons in the ventral horn of exposed spinal cord affords novel insights into the pathophysiology of SBA-like leg dysfunction.
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Affiliation(s)
- Md Sakirul Islam Khan
- Department of Anatomy and Embryology, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan .,Department of Animal Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Hiroaki Nabeka
- Department of Anatomy and Embryology, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
| | - Farzana Islam
- Department of Anatomy and Embryology, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
| | - Tetsuya Shimokawa
- Department of Anatomy and Embryology, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
| | - Shouichiro Saito
- Laboratory of Veterinary Anatomy, Faculty of Applied Biological Sciences, Gifu University, Yanagido, Gifu 501-1128, Japan
| | - Xuan Li
- Department of Anatomy and Embryology, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
| | - Soichiro Kawabe
- Fukui Prefectural Dinosaur Museum, Katsuyama, Fukui 911-8601, Japan
| | - Fumihiko Hamada
- Department of Human Anatomy, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Tetsuya Tachibana
- Department of Agrobiological Science, Faculty of Agriculture, Ehime University, Matsuyama 790-8566, Japan
| | - Seiji Matsuda
- Department of Anatomy and Embryology, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
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Sequential morphological change of Chiari malformation type II following surgical repair of myelomeningocele. Childs Nerv Syst 2016; 32:1069-78. [PMID: 26936599 DOI: 10.1007/s00381-016-3041-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To document long-term morphological changes of Chiari type II malformation (CM-II) following closure of spina bifida manifesta (SBM). METHODS We retrospectively evaluated postnatal magnetic resonance images of the CM-II and posterior fossa (PF) in 28 consecutive cases. We measured changes in vertebral level and length of the cerebellar peg (CP), cerebrospinal fluid (CSF) spaces anterior and posterior to the cerebrospinal junction, PF area, and the anteroposterior diameters of the foramen magnum (FM) and C1 vertebra. We examined the morphological differences between the cases with and without ventriculoperitoneal (VP) shunting and derived predicted means by nonlinear mixed-effect modeling. RESULTS At birth, there were significant differences in CP length, PF area, and FM and C1 diameters between those who underwent VP shunting and those who did not. In cases with a CP below C1, VP shunting was required in every case but one. In those with visible CSF space at birth, VP shunts were not required. In 17 of 18 cases with a CP below C1, the vertebral level ascended by mean two vertebral levels (range 0-5 levels) within 4-6 months of delivery. In the remaining case, slowly progressive hydrocephalus and delayed CP descent required VP shunting at 8 months. Predicted mean CP length and FM and C1 diameters were greater in those who underwent VP shunting, but there was no difference in predicted mean PF area. CONCLUSION The morphology of CM-II and the presence of hydrocephalus influence each other in children who have undergone postnatal SBM repair.
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Kneser U, Bigdeli AK, Himmler JP, Eyüpoglu IY, Ganslandt O, Hirsch A, Schmidt VJ, Beier JP, Horch RE. Comparison of the Ramirez technique for the closure of large open myelomeningocele defects with alternative methods. J Plast Reconstr Aesthet Surg 2015; 68:1675-82. [PMID: 26439172 DOI: 10.1016/j.bjps.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 06/21/2015] [Accepted: 08/10/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND To compare the Ramirez technique for the operative closure of large open myelomeningocele defects with conventional closure techniques in newborns. We hypothesized that the immediate surgical treatment with the Ramirez technique is superior to prior used operative techniques. METHODS From 2003 to 2010, 23 children (8 female, 15 male) underwent closure of large open myelomeningocele defects using the Ramirez technique (group A), while from 1993 to 2002, 23 children (6 female, 17 male) underwent conventional closure techniques (group B). All children were included in the retrospective analysis with a mean follow-up period of 3.4 years. RESULTS Perioperative variables were similar in both groups (P = ns). There were no hospital deaths in both groups. The operation time was significantly higher in group A (228.7 ± 76.8 versus 157.8 ± 70.3 min, P = 0.003). Mean length of hospital stay was significantly lower in group A (30.7 ± 16.4 days versus 52.0 ± 38.5; P = 0.02). Postoperative complication rate was significantly lower in group A (P = 0.01). Beyond postoperative day 10, liquor fluid leakage was significantly lower in group A (P = 0.05). During follow-up, there were no complications in group A. In group B, 2 children developed liquor fistulas. CONCLUSIONS The Ramirez technique allows efficient and safe closure of large open myelomeningocele defects and reduces incidence of postoperative liquor fistulae. The increased operation time and surgical efforts seem to be justified. Treatment of large myelomeningocele defects requires an interdisciplinary team including paediatrician-neonatologists, neurosurgeons and plastic surgeons.
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Affiliation(s)
- Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany; Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Amir K Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany; Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany.
| | - Joerg P Himmler
- Department of Trauma and Orthopedic Surgery, Paracelcus Medical University, Nürnberg, Germany
| | - Ilker Y Eyüpoglu
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Oliver Ganslandt
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Almut Hirsch
- Department of Paediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Volker J Schmidt
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany; Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Justus P Beier
- Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
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Ma W, Wei X, Gu H, Li H, Guan K, Liu D, Chen L, Cao S, An D, Zhang H, Huang T, Miao J, Zhao G, Wu D, Liu B, Wang W, Yuan Z. Sensory neuron differentiation potential of in utero mesenchymal stem cell transplantation in rat fetuses with spina bifida aperta. ACTA ACUST UNITED AC 2015; 103:772-9. [PMID: 26172505 DOI: 10.1002/bdra.23401] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/19/2015] [Accepted: 05/27/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND In previous studies, we found that the deficiency of sensory and motor neurons was a primary defect associated with the spinal malformation. Upon prenatal treatment of spina bifida through in utero stem cell transplantation in a retinoic acid-induced spina bifida rat model, we found that the mesenchymal stem cell (MSCs) survived, migrated, and differentiated into cells of a neural lineage. In the present study, we investigated whether the transplanted MSCs had the potential to differentiate into sensory neurons or to protect sensory neurons in the defective spinal cord. METHODS Pregnant rats treated with retinoic acid on embryonic day (E) 10, underwent fetal surgery for MSC transplantation on E16. The fetuses were harvested on E20. Immunofluorescence was used to detect the expression of Brn3a protein in the transplanted MSCs and dorsal root ganglion (DRG) neurons in the defective spinal cords. The expression of the transcription factors Brn3a and Runx1 in spinal cords was analyzed using real-time polymerase chain reaction. RESULTS Some of the transplanted MSCs expressed sensory neuron cell specific phenotypes. The expression of Brn3a and Runx1 was upregulated in the defective spinal cords when compared to controls. The percentage of Brn3a-positive neurons in DRG was also increased after transplantation. CONCLUSION Our results indicate that the transplantation of MSCs into the spinal cord could promote the transplanted MSCs and the surrounding cells to differentiate toward a sensory neuron cell fate and to play an important role in protecting sensory neurons in DRG. This approach might be of value in the treatment of sensory neuron deficiency in spina bifida aperta.
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Affiliation(s)
- Wei Ma
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Xiaowei Wei
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Hui Gu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Hui Li
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Kaoping Guan
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Dan Liu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Lizhu Chen
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Songying Cao
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Dong An
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Henan Zhang
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Tianchu Huang
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Jianing Miao
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Guifeng Zhao
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Di Wu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Bo Liu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Weilin Wang
- Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Zhengwei Yuan
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
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Li H, Miao J, Zhao G, Wu D, Liu B, Wei X, Cao S, Gu H, Zhang Y, Wang L, Fan Y, Yuan Z. Different expression patterns of growth factors in rat fetuses with spina bifida aperta after in utero mesenchymal stromal cell transplantation. Cytotherapy 2013; 16:319-30. [PMID: 24364908 DOI: 10.1016/j.jcyt.2013.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 10/07/2013] [Accepted: 10/14/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND AIMS In a previous study, we successfully devised a prenatal surgical approach and transplanted mesenchymal stromal cells (MSCs) to fetal rat spinal column to treat retinoic acid-induced neural tube defects in rat. Our results show that MSCs survived, migrated and differentiated into neural lineage cells. We intended to study various growth factor expressions in rat fetal spinal cords with spina bifida aperta after in utero MSC transplantation and the effect of in vivo growth factor introduction for prenatal spina bifida treatment. METHODS Pregnant rats were treated with retinoic acid on embryonic day 10 and then received fetal surgery for MSC transplantation and/or lentiviral epidermal growth factor (EGF) injection on embryonic day 16; various growth factor expression in spinal cords from embryonic day 20 fetuses were analyzed by means of quantitative reverse transcriptase-polymerase chain reaction. Terminal deoxynucleotidyl transferase dUTP nick end labeling analysis was performed to observe spinal tissue apoptosis. RESULTS Growth factor expression was dysregulated in spinal cords with spina bifida. After MSC transplantation, we observed significantly increased expression of EGF, fibroblast growth factor (FGF)-8, FGF-2 and FGF-20 in the MSC transplantation group compared with blank injection; Furthermore, EGF expression positively correlated with surviving MSC amounts. Expression of other growth factors was not significantly different. In vivo EGF introduction reduced spinal tissue apoptosis. CONCLUSIONS Our results suggest that intrinsic EGF and FGF-2, FGF-8 and FGF-20 might affect the in vivo fate of transplanted MSCs in a fetal rat spina bifida model. In vivo EGF introduction together with MSC transplantation might serve as a new strategy for prenatal spina bifida treatment.
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Affiliation(s)
- Hui Li
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Jianing Miao
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Guifeng Zhao
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Di Wu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Bo Liu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Xiaowei Wei
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Songying Cao
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Hui Gu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yi Zhang
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Lili Wang
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yang Fan
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
| | - Zhengwei Yuan
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China.
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Hosper NA, Bank RA, van den Berg PP. Human amniotic fluid-derived mesenchymal cells from fetuses with a neural tube defect do not deposit collagen type i protein after TGF-β1 stimulation in vitro. Stem Cells Dev 2013; 23:555-62. [PMID: 24171700 DOI: 10.1089/scd.2013.0334] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In spina bifida, the neural tube fails to close during the embryonic period. Exposure of the neural tube to the amniotic fluid during pregnancy causes additional neural damage. Intrauterine tissue engineering using a biomaterial seeded with stem cells might prevent this additional damage. For this purpose, autologous cells from the amniotic fluid are an attractive source. To close the defect, it is important that these cells deposit an extracellular matrix. However, it is not known if amniotic fluid mesenchymal cells (AFMCs) from a fetus with a neural tube defect (NTD) share the same characteristics as AFMCs from a healthy fetus. We found that cells derived from fetuses with a NTD, in contrast to healthy human amniotic fluid cells, did not deposit collagen type I. Furthermore, the NTD cells showed, compared with both healthy amniotic fluid cells and fetal fibroblasts, much lower mRNA expression levels of genes that are involved in collagen biosynthesis [procollagen C-endopeptidase enhancer proteins (PCOLCE), PCOLCE2, ADAM metallopeptidase with thrombospondin type 1 motif, 2 (ADAMTS2), ADAMTS14]. This indicates that NTD-AFMCs have different characteristics compared with healthy AFMCs and might not be suitable for fetal therapy to close the defect in spina bifida patients.
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Affiliation(s)
- Nynke A Hosper
- 1 Medical Biology Section, Department of Pathology and Medical Biology, University Medical Centre Groningen , University of Groningen, GZ Groningen, The Netherlands
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Imaging the course of a hypoplastic cerebellum in a spina bifida newborn. Childs Nerv Syst 2013; 29:2131-5. [PMID: 23686389 DOI: 10.1007/s00381-013-2156-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION We report about a spina bifida patient with myelomeningocele at the lumbar level L5, extensive Chiari malformation type II with vermal herniation reaching to C6 with downward pontine shift, and a severe hypoplastic cerebellum. Chromosomal diagnostic tests showed no abnormalities. CASE REPORT The infant experienced severe central apneas successfully treated with oxygen therapy and caffeine medication; functional motor level was established at L5 with sparse anal sphincter function. DISCUSSION After surgical intervention (myelomeningocele repair and ventriculoperitoneal shunt placement), these abnormalities significantly improved on radiological imaging; the preoperative hypoplastic, almost undetectable, cerebellum developed to a fair sized cerebellum. Apneas disappeared over time and the patient showed further developmental improvement. Herein, we illustrate and discuss the changes of the cerebellar volume before and after neurosurgical intervention.
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Morioka T, Hashiguchi K, Mukae N, Sayama T, Sasaki T. Neurosurgical management of patients with lumbosacral myeloschisis. Neurol Med Chir (Tokyo) 2013; 50:870-6. [PMID: 20885122 DOI: 10.2176/nmc.50.870] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Myeloschisis is the most serious and complex congenital anomaly in spina bifida manifesta (cystica). However, with improvements in medical care and increased understanding of its pathophysiology, the associated long-term morbidity and mortality rates have been significantly reduced. This article reviews various issues associated with the neurosurgical management of patients with myeloschisis, such as perinatal management, repair surgery for myeloschisis, neurosurgical management of hydrocephalus, Chiari malformation type II, tethered cord syndrome and epilepsy, and intrauterine fetal surgery.
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Affiliation(s)
- Takato Morioka
- Department of Neurosurgery, Kyushu Rosai Hospital, 1-3-1 Kuzuhara-takamatsu, Fukuoka, Japan.
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Abstract
Recently published results suggest that prenatal repair of fetal myelomeningocele is a potentially preferable alternative when compared to postnatal repair. In this article, the pathology of myelomeningocele, unique physiologic considerations, perioperative anesthetic management, and ethical considerations of open fetal surgery for prenatal myelomeningocele repair are discussed. Open fetal surgeries have many unique anesthetic issues such as inducing profound uterine relaxation, vigilance for maternal or fetal blood loss, fetal monitoring, and possible fetal resuscitation. Postoperative management, including the requirement for postoperative tocolysis and maternal analgesia, are also reviewed. The success of intrauterine myelomeningocele repair relies on a well-coordinated multidisciplinary approach. Fetal surgery is an important topic for anesthesiologists to understand, as the number of fetal procedures is likely to increase as new fetal treatment centers are opened across the United States.
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Buyukkurt S, Binokay F, Seydaoglu G, Kucukgoz Gulec U, Ozgunen FT, Evruke C, Demir C. Prenatal Determination of the Upper Lesion Level of Spina Bifida with Three-Dimensional Ultrasound. Fetal Diagn Ther 2013; 33:36-40. [DOI: 10.1159/000341568] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 06/26/2012] [Indexed: 11/19/2022]
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Saadai P, Wang A, Nout YS, Downing TL, Lofberg K, Beattie MS, Bresnahan JC, Li S, Farmer DL. Human induced pluripotent stem cell-derived neural crest stem cells integrate into the injured spinal cord in the fetal lamb model of myelomeningocele. J Pediatr Surg 2013; 48:158-63. [PMID: 23331809 DOI: 10.1016/j.jpedsurg.2012.10.034] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 10/13/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND/PURPOSE Neurological function in patients with myelomeningocele (MMC) is limited even after prenatal repair. Neural crest stem cells (NCSCs) can improve neurological function in models of spinal cord injury. We aimed to evaluate the survival, integration, and differentiation of human NCSCs derived from induced pluripotent stem cells (iPSC-NCSCs) in the fetal lamb model of MMC. METHODS Human iPSCs derived from skin fibroblasts were differentiated into NCSCs in vitro, mixed with hydrogel, and seeded on nanofibrous scaffolds for surgical transplantation. Fetal lambs (n=2) underwent surgical MMC creation and repair with iPSC-NCSC seeded scaffolds. Gross necropsy and immunohistochemistry were performed at term. RESULTS IPSC-NCSCs expressed NCSC markers, maintained > 95% viability, and demonstrated neuronal differentiation in vitro. Immunohistochemical analysis of repaired spinal cords thirty days after transplantation demonstrated the co-localization of human nuclear mitotic apparatus protein (NuMA) and Neurofilament M subunit (NFM) in the area of spinal cord injury. No gross tumors were identified. CONCLUSIONS Human iPSC-NCSCs survived, integrated, and differentiated into neuronal lineage in the fetal lamb model of MMC. This is the first description of human stem cell engraftment in a model of fetal MMC and supports the concept of using NCSCs to address spinal cord damage in MMC.
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Affiliation(s)
- Payam Saadai
- Division of Pediatric Surgery and Fetal Treatment Center, Department of Surgery, University of California, San Francisco, CA, USA
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Li H, Gao F, Ma L, Jiang J, Miao J, Jiang M, Fan Y, Wang L, Wu D, Liu B, Wang W, Lui VCH, Yuan Z. Therapeutic potential of in utero mesenchymal stem cell (MSCs) transplantation in rat foetuses with spina bifida aperta. J Cell Mol Med 2012; 16:1606-17. [PMID: 22004004 PMCID: PMC3823228 DOI: 10.1111/j.1582-4934.2011.01470.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Neural tube defects (NTDs) are complex congenital malformations resulting from incomplete neurulation in embryo. Despite surgical repair of the defect, most of the patients who survive with NTDs have a multiple system handicap due to neuron deficiency of the defective spinal cord. In this study, we successfully devised a prenatal surgical approach and transplanted mesenchymal stem cells (MSCs) to foetal rat spinal column to treat retinoic acid induced NTDs in rat. Transplanted MSCs survived, grew and expressed markers of neurons, glia and myoblasts in the defective spinal cord. MSCs expressed and perhaps induced the surrounding spinal tissue to express neurotrophic factors. In addition, MSC reduced spinal tissue apoptosis in NTD. Our results suggested that prenatal MSC transplantation could treat spinal neuron deficiency in NTDs by the regeneration of neurons and reduced spinal neuron death in the defective spinal cord.
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Affiliation(s)
- Hui Li
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
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Gu H, Li H, Zhang L, Luan H, Huang T, Wang L, Fan Y, Zhang Y, Liu X, Wang W, Yuan Z. Diagnostic role of microRNA expression profile in the serum of pregnant women with fetuses with neural tube defects. J Neurochem 2012; 122:641-9. [PMID: 22642222 DOI: 10.1111/j.1471-4159.2012.07812.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The discovery of placental microRNAs (miRNAs) in maternal serum has opened up new possibilities for non-invasive prenatal diagnosis. However, the expression of miRNAs in the serum of pregnant women with fetuses with neural tube defects (NTDs) has not been characterized. In this article, we explored serum miRNAs as potential biomarkers in the serum of pregnant women with NTD fetuses. By using a miRNA microarray that covers 887 human miRNAs, we revealed 17 miRNAs with significant change in expression in serum of pregnant women with NTD fetuses and women with normal pregnancies. Quantitative reverse-transcription PCR (qRT-PCR) analysis validated that the expression for six miRNAs (miR-142-3p, miR-144, miR-720, miR-575, miR-765, and miR-1182) was up-regulated and that for miR-1275 was down-regulated. To determine whether these miRNAs were related to pregnancy, we compared the miRNA levels in pre- and post-delivery maternal serum samples. Six of these miRNAs were rapidly reduced in post-delivery serum (p < 0.05). Moreover, by receiver operating characteristic (ROC) curve analysis, the area under the ROC curve (AUC) of combining these six miRNAs was 0.803 (p < 0.001). Thus, we reveal six pregnancy-associated miRNAs that are deregulated in the serum of pregnant women with NTD fetuses and highlight the clinical potential of serum miRNAs as biomarkers for diagnosis and prognostication of fetal NTDs.
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Affiliation(s)
- Hui Gu
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
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Spinner SS, Miesnik SR, Koh JG, Howell LJ. Maternal, Fetal, and Neonatal Care in Open Fetal Surgery for Myelomeningocele. J Obstet Gynecol Neonatal Nurs 2012; 41:447-54. [DOI: 10.1111/j.1552-6909.2012.01357.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Awad RA. Neurogenic bowel dysfunction in patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson’s disease. World J Gastroenterol 2011; 17:5035-48. [PMID: 22171138 PMCID: PMC3235587 DOI: 10.3748/wjg.v17.i46.5035] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/20/2011] [Accepted: 06/27/2011] [Indexed: 02/06/2023] Open
Abstract
Exciting new features have been described concerning neurogenic bowel dysfunction, including interactions between the central nervous system, the enteric nervous system, axonal injury, neuronal loss, neurotransmission of noxious and non-noxious stimuli, and the fields of gastroenterology and neurology. Patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson’s disease present with serious upper and lower bowel dysfunctions characterized by constipation, incontinence, gastrointestinal motor dysfunction and altered visceral sensitivity. Spinal cord injury is associated with severe autonomic dysfunction, and bowel dysfunction is a major physical and psychological burden for these patients. An adult myelomeningocele patient commonly has multiple problems reflecting the multisystemic nature of the disease. Multiple sclerosis is a neurodegenerative disorder in which axonal injury, neuronal loss, and atrophy of the central nervous system can lead to permanent neurological damage and clinical disability. Parkinson's disease is a multisystem disorder involving dopaminergic, noradrenergic, serotoninergic and cholinergic systems, characterized by motor and non-motor symptoms. Parkinson's disease affects several neuronal structures outside the substantia nigra, among which is the enteric nervous system. Recent reports have shown that the lesions in the enteric nervous system occur in very early stages of the disease, even before the involvement of the central nervous system. This has led to the postulation that the enteric nervous system could be critical in the pathophysiology of Parkinson's disease, as it could represent the point of entry for a putative environmental factor to initiate the pathological process. This review covers the data related to the etiology, epidemiology, clinical expression, pathophysiology, genetic aspects, gastrointestinal motor dysfunction, visceral sensitivity, management, prevention and prognosis of neurogenic bowel dysfunction patients with these neurological diseases. Embryological, morphological and experimental studies on animal models and humans are also taken into account.
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Prenatal repair of myelomeningocele with aligned nanofibrous scaffolds-a pilot study in sheep. J Pediatr Surg 2011; 46:2279-83. [PMID: 22152865 DOI: 10.1016/j.jpedsurg.2011.09.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 09/03/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND/PURPOSE Spinal cord damage in myelomeningocele (MMC) results from abnormal cord development and subsequent local trauma. Prenatal surgery prevents additional neural injury. However, existing damage is not reversed. Biodegradable nanofibrous scaffolds (NSs) promote regeneration of neural tissues. They mimic the microtopography of the extracellular matrix and guide tissue formation and organization. The purpose of this pilot study was to evaluate the practicality and safety of using biodegradable NS as a regenerative device in prenatal MMC repair. METHODS Two fetal lambs underwent a surgically induced MMC defect followed by open fetal repair using aligned biodegradable NS. Lambs were killed at day 138. Spinal cords were examined for inflammation or fibrosis and stained for spinal cord architecture, myelin, and neuron cell bodies. RESULTS Prenatal repair with NS demonstrated technical feasibility. There was no evidence of a surrounding inflammatory response or foreign-body reaction to the scaffold. CONCLUSION Biodegradable NS can be used surgically for the prenatal repair of MMC in a large animal model and does not appear to elicit an inflammatory or fibrotic reaction in fetal tissue. Further studies will determine their potential for neural cell infiltration, delivery of growth factors, drugs or stem cells, and functional recovery greater than standard repair.
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Lombardo ML, Watson-Smith DJ, Muratore CS, Carr SR, O'Brien BM, Luks FI. Laser Ablation of Placental Vessels in Twin-to-Twin Transfusion Syndrome: A Paradigm for Endoscopic Fetal Surgery. J Laparoendosc Adv Surg Tech A 2011; 21:869-72. [DOI: 10.1089/lap.2011.0119] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michele L. Lombardo
- Division of Pediatric Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
- The Program in Fetal Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Debra J. Watson-Smith
- Division of Pediatric Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
- The Program in Fetal Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christopher S. Muratore
- Division of Pediatric Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
- The Program in Fetal Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Stephen R. Carr
- The Program in Fetal Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Maternal-Fetal Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Barbara M. O'Brien
- The Program in Fetal Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Maternal-Fetal Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - François I. Luks
- Division of Pediatric Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
- The Program in Fetal Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
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Clayton DB, Tanaka ST, Trusler L, Thomas JC, Pope JC, Adams MC, Brock JW. Long-Term Urological Impact of Fetal Myelomeningocele Closure. J Urol 2011; 186:1581-5. [DOI: 10.1016/j.juro.2011.04.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Indexed: 11/16/2022]
Affiliation(s)
- Douglass B. Clayton
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Stacy T. Tanaka
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Lisa Trusler
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - John C. Thomas
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - John C. Pope
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Mark C. Adams
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - John W. Brock
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
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Watanabe M, Li H, Roybal J, Santore M, Radu A, Jo JI, Kaneko M, Tabata Y, Flake A. A Tissue Engineering Approach for Prenatal Closure of Myelomeningocele: Comparison of Gelatin Sponge and Microsphere Scaffolds and Bioactive Protein Coatings. Tissue Eng Part A 2011; 17:1099-110. [DOI: 10.1089/ten.tea.2010.0390] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Miho Watanabe
- The Department of Surgery and Children's Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatric Surgery, University of Tsukuba, Graduate School of Comprehensive Human Sciences and Clinical Sciences, Tsukuba, Japan
| | - Hiaying Li
- The Department of Surgery and Children's Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jessica Roybal
- The Department of Surgery and Children's Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew Santore
- The Department of Surgery and Children's Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Antonetta Radu
- The Department of Surgery and Children's Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jun-Ichiro Jo
- Department of Biomaterials, Institute for Frontier Medical Sciences, Kyoto, Japan
| | - Michio Kaneko
- Department of Pediatric Surgery, University of Tsukuba, Graduate School of Comprehensive Human Sciences and Clinical Sciences, Tsukuba, Japan
| | - Yasuhiko Tabata
- Department of Biomaterials, Institute for Frontier Medical Sciences, Kyoto, Japan
| | - Alan Flake
- The Department of Surgery and Children's Center for Fetal Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Saadai P, Runyon T, Farmer DL. Fetal neurosurgery: current state of the art. FUTURE NEUROLOGY 2011; 6:165-171. [PMID: 21709818 DOI: 10.2217/fnl.11.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Congenital CNS abnormalities have been targets for prenatal intervention since the founding of fetal surgery 30 years ago, but with historically variable results. Open fetal neurosurgery for myelomenigocele has demonstrated the most promising results of any CNS malformation. Improvements in the understanding of congenital diseases and in fetal surgical techniques have reopened the door to applying fetal surgery to other congenital CNS abnormalities. Advances in gene therapy, bioengineering and neonatal neuroprotection will aid in the future expansion of fetal neurosurgery to other CNS disorders.
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Affiliation(s)
- Payam Saadai
- Fetal Treatment Center, UCSF Benioff Children's Hospital, 513 Parnassus Ave, HSW-1601, Box 0570, San Francisco, CA 94143-0570, USA
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Emejulu JKC, Okwaraoha BO. Peculiarities in cases of spina bifida cystica managed recently in south-east Nigeria: could antimalarial drugs be a major but unrecognized etiologic factor? Pediatr Neurosurg 2011; 47:194-7. [PMID: 22301488 DOI: 10.1159/000334255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 09/25/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spina bifida is a long-known disease arising from the incomplete fusion of the caudal neuropore in the first month of intrauterine life. It is thought to have a multifactorial etiology, the most important of which is folic acid deficiency. In evaluating its etiology, the role of antifolate agents like antimalarial drugs is rarely given a strong mention. METHODS/PATIENTS This is a 44-month prospective study of consecutive cases of spina bifida cystica presenting to the Neurosurgery Unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East Nigeria. Data collection was with a structured proforma from presentation, and collation done with Microsoft Excel broadsheet and data analysis with SPSS and χ2 test. RESULTS A total of 41 cases of spina bifida were attended to within the period, with 92.7% cases of spina bifida cystica. Most presented by >12-24 months, with a consistent history of maternal ingestion of antimalarial drugs during the first trimester of pregnancy. CONCLUSION Spina bifida cystica was diagnosed mostly in children whose mothers ingested antimalarial drugs during the first trimester of gestation. There may be a need to critically evaluate the contribution of antimalarial drugs to the etiopathogenesis of this malformation and develop safer antimalarial treatment in pregnancy.
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Affiliation(s)
- Jude-Kennedy C Emejulu
- Neurosurgery Unit, Department of Surgery, Nnamdi Azikiwe University and Teaching Hospital, Nnewi, Nigeria.
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Alexiou GA, Zarifi MK, Georgoulis G, Mpouza E, Prodromou C, Moutafi A, Anagnostakou M, Sfakianos G, Prodromou N. Cerebral abnormalities in infants with myelomeningocele. Neurol Neurochir Pol 2011; 45:18-23. [DOI: 10.1016/s0028-3843(14)60055-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Saxena AK. Congenital Anomalies of Soft Tissues: Birth Defects Depending on Tissue Engineering Solutions and Present Advances in Regenerative Medicine. TISSUE ENGINEERING PART B-REVIEWS 2010; 16:455-66. [DOI: 10.1089/ten.teb.2009.0700] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Amulya K. Saxena
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
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Abstract
The urologist plays an important role in the multidisciplinary team of physicians who provide care for patients with spina bifida. We review common strategies for managing the urinary tract in these patients. The primary objective in all phases of life is protecting kidney function by minimizing bladder hostility and establishing a good capacity, low-pressure urinary reservoir. Ensuring adequate bladder and bowel continence is also paramount for enhancing self-esteem and independence. Medical therapy incorporating clean intermittent catheterization and antimuscarinic medication is the cornerstone of neurogenic bladder management and often the only intervention required to achieve the above goals. Others may require formal lower urinary tract reconstruction to prevent urinary tract deterioration. As will be shown, current management, while effective, is not supported by strong evidence-based protocols; and the impact of any intervention upon quality of life, while subjectively seen as positive, does not have objective validation. These limitations are recognized and currently the subject of urologic investigation.
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Affiliation(s)
- Douglass B Clayton
- Clinical Fellow in Pediatric Urology, Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee 37232, USA.
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A Tissue Engineering Approach for Prenatal Closure of Myelomeningocele with Gelatin Sponges Incorporating Basic Fibroblast Growth Factor. Tissue Eng Part A 2010; 16:1645-55. [DOI: 10.1089/ten.tea.2009.0532] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Clayton DB, Brock JW. The urologist's role in the management of spina bifida: a continuum of care. Urology 2010; 76:32-8. [PMID: 20350747 DOI: 10.1016/j.urology.2009.12.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 12/02/2009] [Accepted: 12/23/2009] [Indexed: 10/19/2022]
Abstract
Caring for the child with spina bifida necessitates lifelong care by a coordinated team of health care providers, and the urologist plays a vital role in this team. The most important management goal of the urologist is the early establishment and consistent maintenance of a lower pressure urinary reservoir. Ensuring social continence along with its attendant social independence provides some of the greatest management challenges. In those patients who fail medical therapy, surgeons, caregivers, and patients must understand the scope of lower urinary tract reconstruction, the need for strict compliance, and the possibility of future surgery. In this article, we review the recent advances in spina bifida management.
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Affiliation(s)
- Douglass B Clayton
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, TN 37232, USA.
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Beck V, Pexsters A, Gucciardo L, van Mieghem T, Sandaite I, Rusconi S, DeKoninck P, Srisupundit K, Kagan KO, Deprest J. The use of endoscopy in fetal medicine. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s10397-010-0565-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Joó JG, Rigó J. [Significance of magnetic resonance studies in prenatal diagnosis of malformations of the fetal central nervous system]. Orv Hetil 2009; 150:1275-80. [PMID: 19531461 DOI: 10.1556/oh.2009.28626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
MRI investigation, as an imaging technique, has been gaining more and more importance in prenatal diagnostics. It has become essential due to its advantages in diagnosing the malformations of the central nervous system. Similarly to ultrasonography, its reliability is greatly dependent on the knowledge of the person performing the investigation. In addition to the knowledge of the exact anatomy of central nervous system, the researcher should have a multidisciplinary approach. In the case of malformations where repeated investigations are needed to provide a diagnosis in early pregnancy (e.g. neural tube defects), ultrasonography is more effective than MRI. In case of intrauterine infections and malformations of the posterior fossa, however, the two imaging techniques are excellent supplements to each other. MRI also plays an important role in making the prognosis for fetal ventriculomegaly, as well as in the short term diagnosis of ischaemias affecting the fetal nervous system. Difficulties in evaluating ultrasonographic images (owing to maternal obesity, oligohydramnion) render MRI an important technique in making the final diagnosis. Currently, the drawbacks of MRI include reduced accessibility, poor cost-effectiveness and shortage of skilled experts in this technique.
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Affiliation(s)
- József Gábor Joó
- Semmelweis Egyetem, Altalános Orvostudományi Kar, I. Szülészeti és Nogyógyászati Klinika, Budapest.
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Bae DS, Barnewolt CE, Jennings RW. Prenatal diagnosis and treatment of congenital differences of the hand and upper limb. J Bone Joint Surg Am 2009; 91 Suppl 4:31-9. [PMID: 19571065 DOI: 10.2106/jbjs.i.00072] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Donald S Bae
- Department of Orthopaedic Surgery, Children's Hospital Boston, Hunnewell 2, Boston, MA 02115, USA.
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Fetal MRI in the evaluation of fetuses referred for sonographically suspected neural tube defects (NTDs): impact on diagnosis and management decision. Neuroradiology 2009; 51:761-72. [DOI: 10.1007/s00234-009-0549-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 06/09/2009] [Indexed: 12/21/2022]
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Klaritsch P, Albert K, Van Mieghem T, Gucciardo L, Done’ E, Bynens B, Deprest J. Instrumental requirements for minimal invasive fetal surgery. BJOG 2008; 116:188-97. [DOI: 10.1111/j.1471-0528.2008.02021.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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