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Sayols N, Hernansanz A, Parra J, Eixarch E, Xambó-Descamps S, Gratacós E, Casals A. Robust tracking of deformable anatomical structures with severe occlusions using deformable geometrical primitives. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 251:108201. [PMID: 38703719 DOI: 10.1016/j.cmpb.2024.108201] [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: 03/27/2023] [Revised: 01/30/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND OBJECTIVE Surgical robotics tends to develop cognitive control architectures to provide certain degree of autonomy to improve patient safety and surgery outcomes, while decreasing the required surgeons' cognitive load dedicated to low level decisions. Cognition needs workspace perception, which is an essential step towards automatic decision-making and task planning capabilities. Robust and accurate detection and tracking in minimally invasive surgery suffers from limited visibility, occlusions, anatomy deformations and camera movements. METHOD This paper develops a robust methodology to detect and track anatomical structures in real time to be used in automatic control of robotic systems and augmented reality. The work focuses on the experimental validation in highly challenging surgery: fetoscopic repair of Open Spina Bifida. The proposed method is based on two sequential steps: first, selection of relevant points (contour) using a Convolutional Neural Network and, second, reconstruction of the anatomical shape by means of deformable geometric primitives. RESULTS The methodology performance was validated with different scenarios. Synthetic scenario tests, designed for extreme validation conditions, demonstrate the safety margin offered by the methodology with respect to the nominal conditions during surgery. Real scenario experiments have demonstrated the validity of the method in terms of accuracy, robustness and computational efficiency. CONCLUSIONS This paper presents a robust anatomical structure detection in present of abrupt camera movements, severe occlusions and deformations. Even though the paper focuses on a case study, Open Spina Bifida, the methodology is applicable in all anatomies which contours can be approximated by geometric primitives. The methodology is designed to provide effective inputs to cognitive robotic control and augmented reality systems that require accurate tracking of sensitive anatomies.
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Affiliation(s)
- Narcís Sayols
- Center of Research in Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain; Simulation, Imaging and Modelling for Biomedical Systems Research Group (SIMBiosys), Universitat Pompeu Fabra, Barcelona, Spain.
| | - Albert Hernansanz
- Center of Research in Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain; SurgiTrainer SL., Barcelona, Spain; Simulation, Imaging and Modelling for Biomedical Systems Research Group (SIMBiosys), Universitat Pompeu Fabra, Barcelona, Spain
| | - Johanna Parra
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain
| | - Elisenda Eixarch
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - Sebastià Xambó-Descamps
- Department of Mathematics, Universitat Politècnica de Catalunya, Barcelona, Spain; Mathematical Institute (IMTech), Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Eduard Gratacós
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - Alícia Casals
- Center of Research in Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain; SurgiTrainer SL., Barcelona, Spain
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Lee SY, Du Y, Hassan AES, Brown E, Saadai P, Hirose S, Wang A, Farmer DL. Evolution and Variations of the Ovine Model of Spina Bifida. Fetal Diagn Ther 2023; 50:491-500. [PMID: 37393899 PMCID: PMC10757987 DOI: 10.1159/000531750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/08/2023] [Indexed: 07/04/2023]
Abstract
Spina bifida is the most common congenital anomaly of the central nervous system and the first non-fatal fetal lesions to be addressed by fetal intervention. While research in spina bifida has been performed in rodent, nonhuman primate, and canine models, sheep have been a model organism for the disease. This review summarizes the history of development of the ovine model of spina bifida, previous applications, and translation into clinical studies. Initially used by Meuli et al. [Nat Med. 1995;1(4):342-7], fetal myelomeningocele defect creation and in utero repair demonstrated motor function preservation. The addition of myelotomy in this model can reproduce hindbrain herniation malformations, which is the leading cause of mortality and morbidity in humans. Since inception, the ovine models have been validated numerous times as the ideal large animal model for fetal repair, with both locomotive scoring and spina bifida defect scoring adding to the rigor of this model. The ovine model has been used to study different methods of myelomeningocele defect repair, the application of various tissue engineering techniques for neuroprotection and bowel and bladder function. The results of these large animal studies have been translated into human clinical trials including Management of Meningocele Study (MOMS) trial that established current standard of care for prenatal repair of spina bifida defects, and the ongoing trials including the Cellular Therapy for In Utero Repair of Myelomeningocele (CuRe) trial using a stem cell patch for repair. The advancement of these life savings and life-altering therapies began in sheep models, and this notable model continues to be used to further the field including current work with stem cell therapy.
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Affiliation(s)
- Su Yeon Lee
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, Sacramento, California, USA,
- Center for Surgical Bioengineering, University of California Davis, Sacramento, California, USA,
| | - Yimeng Du
- University of California Davis School of Medicine, Sacramento, California, USA
| | - Abd-Elrahman Said Hassan
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, Sacramento, California, USA
- Center for Surgical Bioengineering, University of California Davis, Sacramento, California, USA
| | - Erin Brown
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Payam Saadai
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Shinjiro Hirose
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Aijun Wang
- Center for Surgical Bioengineering, University of California Davis, Sacramento, California, USA
| | - Diana L Farmer
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, Sacramento, California, USA
- Center for Surgical Bioengineering, University of California Davis, Sacramento, California, USA
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Spoor JKH, van Gastel L, Tahib F, van Grieken A, van Weteringen W, Sterke F, Baschat AA, Miller JL, de Jong THR, Wijnen RMH, Eggink AE, DeKoninck PLJ. Development of a simulator for training of fetoscopic myelomeningocele surgery. Prenat Diagn 2023; 43:355-358. [PMID: 36627260 DOI: 10.1002/pd.6308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/19/2022] [Accepted: 01/02/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To develop a realistic simulation model for laparotomy-assisted fetoscopic spina bifida aperta (SBa) surgery, to be used for training purposes and preoperative planning. METHODS The predefined general requirement was a realistic model of an exteriorized uterus, allowing all neurosurgical steps of the intervention. The uterus was modelled using ultrasound and MRI images of a 25 weeks' gravid uterus, consisting of flexible polyurethane foam coated with pigmented silicone. The fetal model, contained an opening on the dorsal side for a customizable spinal insert with all the aspects of a SBa, including a cele, placode, and myofascial and skin layer. The model was assessed in a series of validation experiments. RESULTS Production costs are low, uterus and fetus are reusable. Placental localization and the level and size of the spinal defect are adjustable, enabling case-specific adaptations. All aspects of the simulator were scored close to realistic or higher for both appearance and functional capacities. CONCLUSIONS This innovative model provides an excellent training opportunity for centers that are starting a fetoscopic SBa repair program. It is the first simulation model with adjustable spinal defect and placental localisation. Further objective validation is required, but the potential for using this model in preoperative planning is promising.
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Affiliation(s)
- Jochem K H Spoor
- Departments of Neurosurgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lis van Gastel
- Departments of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fatima Tahib
- Departments of Neurosurgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Amanda van Grieken
- Departments of Neurosurgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willem van Weteringen
- Departments of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank Sterke
- Departments of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Ahmet A Baschat
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jena L Miller
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tjeerd H R de Jong
- Departments of Neurosurgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - René M H Wijnen
- Departments of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alex E Eggink
- Departments of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Philip L J DeKoninck
- Departments of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Thompson DNP, De Vloo P, Deprest J. Fetal Surgery for Myelomeningocele: Neurosurgical Perspectives. Adv Tech Stand Neurosurg 2023; 47:25-48. [PMID: 37640871 DOI: 10.1007/978-3-031-34981-2_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
More than 30 years have elapsed since it was recognised that folic acid supplementation could substantially reduce the risk of open neural tube defects (ONTDs). During that time, many countries have adopted policies of food fortification with demonstrable reduction in the incidence of both cranial and spinal ONTDs. Improved prenatal detection and termination has also resulted in a reduction in the number of affected live births. Nonetheless, in the USA about 1500 children, and in the UK around 500 children are born each year with myelomeningocele (MMC) and so the management of MMC and its complications continues to constitute a significant clinical workload for many paediatric neurosurgical units around the world.Until recently, the options available following antenatal diagnosis of MMC were termination of pregnancy or postnatal repair. As a result of the MOMS trial, prenatal repair has become an additional option in selected cases (Adzick et al., N Engl J Med 364(11):993-1004, 2011). Fetal surgery for myelomeningocele is now offered in more than 30 centres worldwide. The aim of this chapter is to review the experimental basis of prenatal repair of MMC, to critically evaluate the neurosurgical implications of this intervention and to describe the technique of 'open' repair, comparing this with emerging minimally invasive alternatives.
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Affiliation(s)
- Dominic N P Thompson
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK.
| | | | - Jan Deprest
- Department of Obstetrics and Gynaecology, UZ Leuven, Leuven, Belgium
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Molina-Giraldo S, Zapata Salcedo R, Rojas Arias JL, Acuña Osorio E, Pinto Quiñones ML, Restrepo HF, Cruz-Martinez R. Open surgery for in utero repair of spina bifida: Microneurosurgery versus standard technique - A systematic review. Prenat Diagn 2021; 41:1615-1623. [PMID: 34676573 DOI: 10.1002/pd.6063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/08/2021] [Accepted: 10/19/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Prenatal myelomeningocele (MMC) repair has been shown to improve neurological outcomes. It has been suggested that decreases in the hysterotomy diameter during surgery can improve perinatal outcomes without altering neurologic outcomes. The objective of this study is to describe and compare the main maternal and fetal outcomes of fetuses undergoing open surgery for MMC repair, through the different modifications (standard-classical, mini-hysterotomy, and microneurosurgery). DATA SOURCE MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Ovid, SciELO, LILACS, PROSPERO. RESULTS From a total of 112 studies, seven case series were selected including 399 fetuses with open fetal surgery, five studies using the classical technique (n = 181), one with mini-hysterotomy (n = 176), and one with the microneurosurgery technique (n = 42). The mini-hysterotomy and microneurosurgery techniques presented a lower risk of preterm delivery (21.4% and 30%, respectively) compared to the classic technique (47.3%), premature rupture of membranes (78%, 62%, and 72.5 %, respectively), oligohydramnios (0% and 72.5%, respectively), dehiscence of hysterotomy, maintaining the same frequency of Chiari reversion (78%, 62%, and 72.5%, respectively), postnatal correction requirement (0%, 4.8%, and 5.8%, respectively), and lower frequency of requirement for a ventriculoperitoneal shunt placement (13.0%, 7.5%, and 29.1%, respectively). CONCLUSION The least invasive techniques (minihysterotomy-microneurosurgery) are possible and reproduceable, as they are associated with better maternal and perinatal outcomes.
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Affiliation(s)
- Saulo Molina-Giraldo
- Section of Fetal Therapy and Fetal Surgery Unit, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology Hospital de San José, Fundación Universitaria de Ciencias de la Salud - FUCS, FetoNetwork Colombia, Bogotá, Colombia.,Section of Fetal Therapy and Fetal Surgery Unit, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Clínica Colsubsidio 94, Bogotá, Colombia
| | - Roberto Zapata Salcedo
- Section of Fetal Therapy and Fetal Surgery Unit, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology Hospital de San José, Fundación Universitaria de Ciencias de la Salud - FUCS, FetoNetwork Colombia, Bogotá, Colombia
| | - José Luis Rojas Arias
- Section of Fetal Therapy and Fetal Surgery Unit, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology Hospital de San José, Fundación Universitaria de Ciencias de la Salud - FUCS, FetoNetwork Colombia, Bogotá, Colombia
| | - Edgar Acuña Osorio
- Section of Fetal Therapy and Fetal Surgery Unit, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology Hospital de San José, Fundación Universitaria de Ciencias de la Salud - FUCS, FetoNetwork Colombia, Bogotá, Colombia
| | - Martha Lucia Pinto Quiñones
- Section of Fetal Therapy and Fetal Surgery Unit, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology Hospital de San José, Fundación Universitaria de Ciencias de la Salud - FUCS, FetoNetwork Colombia, Bogotá, Colombia.,Section of Fetal Therapy and Fetal Surgery Unit, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Clínica Colsubsidio 94, Bogotá, Colombia
| | - Hector Fabio Restrepo
- Research Division, Fundación Universitaria de Ciencias de la Salud - FUCS Bogotá, Bogotá, Colombia
| | - Rogelio Cruz-Martinez
- Unidad de Cirugía Fetal, Hospital de Especialidades del Niño y la Mujer, y Centro de Diagnóstico Prenatal Avanzado y Cirugía Fetal, Medicina Fetal México, Querétaro, México
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6
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Jouannic JM, Guilbaud L, Maurice P, Maisonneuve E, de Saint Denis T, du Peuty C, Zerah M. [The ethics of fetal myelomeningocele surgery]. ACTA ACUST UNITED AC 2021; 50:189-193. [PMID: 34656790 DOI: 10.1016/j.gofs.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Indexed: 10/20/2022]
Abstract
Fetal myelomeningocele surgery was introduced in France in 2014. Developments in prenatal diagnosis of neural tube defects have accompanied the development of prenatal diagnosis. This fetal surgery represents one of the three possible care paths for pregnant women faced with this prenatal diagnosis. The ethical issues of this fetal surgery are discussed and in particular regarding prenatal counselling and patient autonomy of choice.
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Affiliation(s)
- J-M Jouannic
- Service de médecine fœtale, Sorbonne Université, AP-HP Sorbonne Université, Hôpital Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France; Centre de référence Maladies Rares C-MAVEM, Hôpital Armand Trousseau, AP-HP Sorbonne Université, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France.
| | - L Guilbaud
- Service de médecine fœtale, Sorbonne Université, AP-HP Sorbonne Université, Hôpital Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France; Centre de référence Maladies Rares C-MAVEM, Hôpital Armand Trousseau, AP-HP Sorbonne Université, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France
| | - P Maurice
- Service de médecine fœtale, Sorbonne Université, AP-HP Sorbonne Université, Hôpital Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France; Centre de référence Maladies Rares C-MAVEM, Hôpital Armand Trousseau, AP-HP Sorbonne Université, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France
| | - E Maisonneuve
- Service de médecine fœtale, Sorbonne Université, AP-HP Sorbonne Université, Hôpital Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France; Centre de référence Maladies Rares C-MAVEM, Hôpital Armand Trousseau, AP-HP Sorbonne Université, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France
| | - T de Saint Denis
- Centre de référence Maladies Rares C-MAVEM, Hôpital Armand Trousseau, AP-HP Sorbonne Université, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France; Service de neurochirurgie pédiatrique, Hôpital Necker, Université de Paris, 149, rue du Sèvres, 75015 Paris, France
| | - C du Peuty
- Service de médecine fœtale, Sorbonne Université, AP-HP Sorbonne Université, Hôpital Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France
| | - M Zerah
- Centre de référence Maladies Rares C-MAVEM, Hôpital Armand Trousseau, AP-HP Sorbonne Université, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France; Service de neurochirurgie pédiatrique, Hôpital Necker, Université de Paris, 149, rue du Sèvres, 75015 Paris, France
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Sbragia L, da Costa KM, Nour ALA, Ruano R, Santos MV, Machado HR. State of the art in translating experimental myelomeningocele research to the bedside. Childs Nerv Syst 2021; 37:2769-2785. [PMID: 34333685 DOI: 10.1007/s00381-021-05299-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
Myelomeningocele (MMC), the commonest type of spina bifida (SB), occurs due to abnormal development of the neural tube and manifest as failure of the complete fusion of posterior arches of the spinal column, leading to dysplastic growth of the spinal cord and meninges. It is associated with several degrees of motor and sensory deficits below the level of the lesion, as well as skeletal deformities, bladder and bowel incontinence, and sexual dysfunction. These children might develop varying degrees of neuropsychomotor delay, partly due to the severity of the injuries that affect the nervous system before birth, partly due to the related cerebral malformations (notably hydrocephalus-which may also lead to an increase in intracranial pressure-and Chiari II deformity). Traditionally, MMC was repaired surgically just after birth; however, intrauterine correction of MMC has been shown to have several potential benefits, including better sensorimotor outcomes (since exposure to amniotic fluid and its consequent deleterious effects is shortened) and reduced rates of hydrocephalus, among others. Fetal surgery for myelomeningocele, nevertheless, would not have been made possible without the development of experimental models of this pathological condition. Hence, the aim of the current article is to provide an overview of the animal models of MMC that were used over the years and describe how this knowledge has been translated into the fetal treatment of MMC in humans.
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Affiliation(s)
- Lourenço Sbragia
- Division of Pediatric Surgery - Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Karina Miura da Costa
- Division of Pediatric Surgery - Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Antonio Landolffi Abdul Nour
- Division of Pediatric Surgery - Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas, Houston, TX, USA
| | - Marcelo Volpon Santos
- Division of Pediatric Neurosurgery - Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Hélio Rubens Machado
- Division of Pediatric Neurosurgery - Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Guilbaud L, Zerah M, Jouannic JM, Quarello E. [The paradoxes of spina bifida in the prenatal period]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:569-572. [PMID: 33989830 DOI: 10.1016/j.gofs.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Indexed: 06/12/2023]
Affiliation(s)
- L Guilbaud
- Service de médecine fœtale, Sorbonne université, AP-HP, hôpital Armand-Trousseau, 26, avenue du Docteur Arnold Netter, 75012 Paris, France; Centre de référence maladies rares C-MAVEM, hôpital Armand-Trousseau, 26, avenue du Docteur Arnold Netter, 75012 Paris, France
| | - M Zerah
- Centre de référence maladies rares C-MAVEM, hôpital Armand-Trousseau, 26, avenue du Docteur Arnold Netter, 75012 Paris, France; Service de neurochirurgie pédiatrique, hôpital Necker, Université de Paris, 149, rue du Sèvres, 75015 Paris, France
| | - J-M Jouannic
- Service de médecine fœtale, Sorbonne université, AP-HP, hôpital Armand-Trousseau, 26, avenue du Docteur Arnold Netter, 75012 Paris, France; Centre de référence maladies rares C-MAVEM, hôpital Armand-Trousseau, 26, avenue du Docteur Arnold Netter, 75012 Paris, France
| | - E Quarello
- Institut méditerranéen d'imagerie médicale appliquée à la gynécologie, la grossesse et l'enfance IMAGE(2), 6, rue Rocca, 13008 Marseille, France; Unité de dépistage et de diagnostic prénatal, hôpital Saint-Joseph, 26, boulevard de Louvain, 13285 Marseille cedex, France.
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Amini M, Pashmdarfard M. The Effect of Poetry and Rhythmic Movements Therapy on Reducing Childhood Anxiety of a Child with Myelomeningocele: A Case Report. FUNCTION AND DISABILITY JOURNAL 2019. [DOI: 10.30699/fdisj.2.1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Lobo GJ, Nayak M. V-Y Plasty or Primary Repair Closure of Myelomeningocele: Our Experience. J Pediatr Neurosci 2018; 13:398-403. [PMID: 30937079 PMCID: PMC6413606 DOI: 10.4103/jpn.jpn_40_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Open neural tube defects in the spine most commonly are in the lumbo-sacral region. Surgical closure is the treatment, but in primary closure the chances of CSF leak are more. Hence a novel technique of using an advancement flap called the V-Y plasty for closure of these defects(6). Our study compares the outcomes of primary closure and V-Y plasty in the closure of Myelomeningocoeles. Methods: A prospective study of the infants who underwent surgical repair for MMC at our hospital from August 2014- January 2018 were included in the study. Total of 22 infants were treated, 9 underwent primary repair and 13 underwent V-Y plasty. Results: The time taken for primary closure was a mean of 120 min, while the advancement flap took longer of 190.7 min. All the 9 who underwent primary closure had CSF leak, 3 developed hydrocephalus, 6 had wound dehiscence, 3 had neurological deficits and 1 died. Of the 13 infants who underwent V-Y plasty 3 had CSF leaks, 1 had hydrocephalus, 5 had neurological deficits and no wound dehiscence or deaths. Conclusion: The aim of surgical repair is to cover the exposed neural tissue, prevent CSF leak and reduce CNS infections. V-Y plasty a plastic surgical technique of advancement flaps with intact pedicles improves the outcome of skin closure once the neural placode is placed in the dura and closed. This reduces the morbidity in a one-time procedure.
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Affiliation(s)
- Geover Joslen Lobo
- Department of Neurosurgery, Father Muller Medical College, Mangaluru, Karnataka, India
| | - Madhukar Nayak
- Department of Neurosurgery, Father Muller Medical College, Mangaluru, Karnataka, India
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