1
|
Chavelas-Ochoa F, Bermúdez-Rojas MDLL, Medina-Jiménez V, Helue-Mena A, Gil-Pugliese S, Gutiérrez-Gómez I, Martínez-Rodríguez M, Gaona-Tapia CJ, Villalobos-Gómez R, Aguilar-Vidales K, Cruz-Martínez R. Double Myelomeningocele Repair by Fetal Surgery with a Single Micro-Hysterotomy. Pediatr Neurosurg 2024; 59:87-93. [PMID: 38342093 DOI: 10.1159/000537723] [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: 08/17/2023] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Open spina bifida (OSB) is the most common congenital anomaly of the central nervous system. It is associated with severe neurodevelopmental delay, motor impairment, hydrocephalus, and bowel and bladder dysfunction. In selected cases, intrauterine spina bifida repair has been shown to improve neonatal outcomes. Rarely, the spine can have a double defect compromising two different segments and there is a lack of evidence on the feasibility and benefits of intrauterine repair in these cases. CASE PRESENTATION We present a case with both cervicothoracic and lumbosacral myelomeningocele, Arnold-Chiari malformation type II and bilateral ventriculomegaly, that was treated successfully at 25 weeks with open micro-neurosurgery. Double myelomeningocele was successfully treated through a single 2-cm micro-hysterotomy, by performing external versions to sequentially expose and repair both defects. Weekly postoperative follow-up showed no progression of ventriculomegaly or complications attributable to the procedure. Preterm rupture of membranes prompted a conventional cesarean delivery at 32 weeks of gestation. Neurodevelopmental outcome at 20 months was within normal ranges, having achieved ambulation without orthopedic support and with no need for ventriculoperitoneal shunting. CONCLUSION This report demonstrates for the first time the feasibility of double OSB repair through a single 2-cm micro-hysterotomy, suggesting that selected isolated cases of double myelomeningocele could be candidates for fetal intervention. Further prospective studies should be carried out to assess the potential benefit of double OSB intrauterine open repair.
Collapse
Affiliation(s)
- Felipe Chavelas-Ochoa
- Department of Pediatric Neurosurgery, Women and Children Specialty Hospital "Dr. Felipe Núñez-Lara", Queretaro, Mexico
| | | | - Virginia Medina-Jiménez
- State Center for Timely Prenatal Screening, Maternal and Child Hospital of Leon, Guanajuato, Mexico
| | - Antonio Helue-Mena
- Department of Maternal-Fetal Medicine, National Medical Center "La Raza", Mexico City, Mexico
| | - Savino Gil-Pugliese
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
| | - Ivan Gutiérrez-Gómez
- Department of Maternal-Fetal Medicine, National Medical Center "La Raza", Mexico City, Mexico
| | | | | | - Rosa Villalobos-Gómez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
| | - Karla Aguilar-Vidales
- Department of Pediatric Neurosurgery, Women and Children Specialty Hospital "Dr. Felipe Núñez-Lara", Queretaro, Mexico
| | - Rogelio Cruz-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico Institute, Guadalajara, Mexico
| |
Collapse
|
2
|
Vergote S, Joyeux L, Basurto D, Bleeser T, Valenzuela I, Valentyn B, Emam D, Watananirun K, De Bie FR, Aertsen M, van der Merwe J, Deprest J. Duration of fetoscopic spina bifida repair does not affect the central nervous system in fetal lambs. Am J Obstet Gynecol MFM 2023; 5:101156. [PMID: 37714330 DOI: 10.1016/j.ajogmf.2023.101156] [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] [Received: 07/25/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Prenatal spina bifida aperta repair improves neurologic outcomes yet comes with a significant risk of prematurity and uterine scar-related complications. To reduce such complications, different fetoscopic techniques, for example, with varying numbers of ports, are being explored. This has an effect on the duration of the procedure, potentially affecting central nervous system development. Both the condition and anesthesia can affect the central nervous system, particularly the hippocampus, a region crucial for prospective and episodic memory. Previous animal studies have shown the potential influence of anesthesia, premature delivery, and maternal surgery during pregnancy on this area. OBJECTIVE This study aimed to compare the effects of 2- vs 3-port fetoscopic spina bifida aperta repair in the fetal lamb model using neuron count of the hippocampus as the primary outcome. STUDY DESIGN Based on the hippocampal neuron count from previous lamb experiments, we calculated that we required 5 animals per group to achieve a statistical power of ≥ 80%. A spina bifida aperta defect was developed in fetal lambs at 75 days of gestation (term: 145 days). At 100 days, fetuses underwent either a 2-port or 3-port fetoscopic repair. At 143 days, all surviving fetuses were delivered by cesarean delivery, anesthetized, and transcardially perfused with a mixture of formaldehyde and gadolinium. Next, they underwent neonatal brain and spine magnetic resonance imaging after which these organs were harvested for histology. Hippocampus, frontal cortex, caudate nucleus, and cerebellum samples were immunostained to identify neurons, astrocytes, microglia, and markers associated with cell proliferation, myelination, and synapses. The degree of hindbrain herniation and the ventricular diameter were measured on magnetic resonance images and volumes of relevant brain and medulla areas were segmented. RESULTS Both treatment groups included 5 fetuses and 9 unoperated littermates served as normal controls. The durations for both skin-to-skin (341±31 vs 287±40 minutes; P=.04) and fetal surgery (183±30 vs 128±22; P=.01) were longer for the 2-port approach than for the 3-port approach. There was no significant difference in neuron density in the hippocampus, frontal cortex, and cerebellum. In the caudate nucleus, the neuron count was higher in the 2-port group (965±156 vs 767±92 neurons/mm2; P=.04). There were neither differences in proliferation, astrogliosis, synaptophysin, or myelin. The tip of the cerebellar vermis was closer to the foramen magnum in animals undergoing the 2-port approach than in animals undergoing the 3-port approach (-0.72±0.67 vs -2.47±0.91 mm; P=.009). There was no significant difference in the ratio of the hippocampus, caudate nucleus, or cerebellar volume to body weight. For the spine, no difference was noted in spine volume-to-body weight ratio for the lower (L1-L2), middle (L3-L4), and higher (L5-L6) levels. Compared with controls, in repaired animals, the cerebellar vermis tip laid closer to the foramen magnum, parietal ventricles were enlarged, and medulla volumes were reduced. CONCLUSION In the experimental spina bifida fetal lamb model, a 2-port repair took 40% longer than a 3-port repair. However, there was no indication of any relevant morphologic differences in the fetal brain.
Collapse
Affiliation(s)
- Simen Vergote
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest)
| | - Luc Joyeux
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX (Dr Joyeux)
| | - David Basurto
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Fetal Medicine and Fetal Surgery, National Institute of Perinatology, Mexico City, Mexico (Dr Basurto)
| | - Tom Bleeser
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Anaesthesiology, Universitair Ziekenhuis Leuven, Leuven, Belgium (Dr Bleeser); Department of Cardiovascular Sciences, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Dr Bleeser)
| | - Ignacio Valenzuela
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest)
| | - Britt Valentyn
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest)
| | - Doaa Emam
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Obstetrics and Gynaecology, Tanta University Hospitals, Tanta, Egypt (Dr Emam)
| | - Kanokwaroon Watananirun
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Faculty of Medicine, Department of Obstetrics and Gynecology, Siriraj Hospital, Mahidol University, Bangkok, Thailand (Dr Watananirun)
| | - Felix R De Bie
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest)
| | - Michael Aertsen
- Department of Imaging and Pathology, Clinical Department of Radiology, University Hospitals Katholieke Universiteit Leuven, Leuven, Belgium (Dr Aertsen)
| | - Johannes van der Merwe
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest)
| | - Jan Deprest
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Drs Vergote, Joyeux, Basurto, Bleeser, and Valenzuela, Ms Valentyn, and Drs Emam, Watananirun, De Bie, van der Merwe, and Deprest); Institute for Women's Health, University College London, London, United Kingdom (Dr Deprest).
| |
Collapse
|
3
|
Vergote S, Van der Stock J, Kunpalin Y, Bredaki E, Maes H, Banh S, De Catte L, Devlieger R, Lewi L, Devroe S, Spencer R, David A, De Vloo P, Van Calenbergh F, Deprest JA. Patient empowerment improves follow-up data collection after fetal surgery for spina bifida: institutional audit. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:565-572. [PMID: 37099513 DOI: 10.1002/uog.26230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES To define and grade fetal and maternal adverse events following fetal surgery for spina bifida and to report on the impact of engaging patients in collecting follow-up data. METHODS This prospective single-center audit included 100 consecutive patients undergoing fetal surgery for spina bifida between January 2012 and December 2021. In our setting, patients return to their referring unit for further pregnancy care and delivery. On discharge, referring hospitals were requested to return outcome data. For this audit, we prompted patients and referring hospitals to provide data in cases of missing outcomes. Outcomes were categorized as missing, returned spontaneously or returned following additional request, by the patient and/or referring center. Postoperative maternal and fetal complications until delivery were defined and graded according to Maternal and Fetal Adverse Event Terminology (MFAET) and the Clavien-Dindo classification. RESULTS There were no maternal deaths, but severe maternal complications occurred in seven women (anemia in pregnancy, postpartum hemorrhage, pulmonary edema, lung atelectasis, urinary tract obstruction and placental abruption). No cases of uterine rupture were reported. Perinatal death occurred in 3% of fetuses and other severe fetal complications in 15% (perioperative fetal bradycardia/cardiac dysfunction, fistula-related oligohydramnios, chorioamnionitis and preterm prelabor rupture of membranes (PPROM) before 32 weeks). PPROM occurred in 42% of patients and, overall, delivery took place at a median gestational age of 35.3 weeks (interquartile range, 34.0-36.6 weeks). Information provided following additional request, from both centers and patients but mainly from the latter, reduced missing data by 21% for gestational age at delivery, 56% for uterine-scar status at birth and 67% for shunt insertion at 12 months. Compared with the generic Clavien-Dindo classification, the MFAET system ranked complications in a more clinically relevant way. CONCLUSIONS The nature and rate of severe complications following fetal surgery for spina bifida were similar to those reported in other large series. Spontaneous return of outcome data by referring centers was low, yet patient empowerment improved data collection. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- S Vergote
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - J Van der Stock
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Y Kunpalin
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Institute for Women's Health, University College London, London, UK
| | - E Bredaki
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Institute for Women's Health, University College London, London, UK
| | - H Maes
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - S Banh
- Institute for Women's Health, University College London, London, UK
| | - L De Catte
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - R Devlieger
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - L Lewi
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - S Devroe
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - R Spencer
- Institute for Women's Health, University College London, London, UK
| | - A David
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Institute for Women's Health, University College London, London, UK
| | - P De Vloo
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - F Van Calenbergh
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - J A Deprest
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Institute for Women's Health, University College London, London, UK
| |
Collapse
|
4
|
Ruegg L, Vonzun L, Latal B, Moehrlen U, Mazzone L, Meuli M, Krähenmann F, Ochsenbein-Kölble N. Impact on postoperative, neonatal and 2-year neurodevelopmental outcomes of UA-AREDF during and after fetal spina bifida repair. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:734-739. [PMID: 36357943 DOI: 10.1002/uog.26118] [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: 07/06/2022] [Revised: 10/07/2022] [Accepted: 10/18/2022] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Absent or reversed end-diastolic flow (AREDF) in the umbilical artery (UA) on Doppler is a known phenomenon during fetal interventions, such as fetal open spina bifida (OSB) repair. We aimed to evaluate the clinical importance of these Doppler findings by investigating the impact of UA-AREDF on postoperative, neonatal and 2-year neurodevelopmental outcomes. METHODS This was a prospective study of pregnancies undergoing fetal OSB repair at the Zurich Center for Fetal Diagnosis and Therapy between 2010 and 2019. The group with UA-AREDF during or immediately after the intervention was compared to the group with normal UA Doppler. Primary endpoint was the FIGO scores of cardiotocography (CTG) 1, 2 and 6 h postoperatively and on day 1 after surgery. Secondary endpoints were the neonatal parameters and 2-year neurodevelopmental outcome assessed using the Bayley Scales of Infant and Toddler Development, Third Edition. RESULTS Data of 130 patients were analyzed. None of the fetuses had UA-AREDF before OSB repair. Normal UA Doppler was observed in 107 (82%) patients and UA-AREDF was observed in 23 (18%) during or immediately after OSB surgery. UA-AREDF was more often observed after version of the fetus (P = 0.045). Seventeen (13%) cases had absent end-diastolic flow (UA-AEDF) and six (5%) cases had reversed end-diastolic flow (UA-REDF). UA-AREDF disappeared in all 23 cases within the first day after OSB surgery. One-third of all CTGs were restricted in oscillation after surgery, but no significant difference in CTG 1, 2 and 6 h postoperatively or on the first postoperative day was found between the UA-AREDF and normal-Doppler groups (P > 0.05). Gestational age at delivery, UA pH, 5-min Apgar score and birth weight were comparable between the two groups, and there was no difference in the 2-year neurodevelopmental outcome (P > 0.05). The neonatal and 2-year neurodevelopmental outcomes also did not differ significantly between the UA-REDF and UA-AEDF groups. CONCLUSIONS Postoperative CTG abnormalities occur and recover at a similar rate in fetuses with transitory UA-AREDF and those with normal Doppler during fetal OSB repair. UA-AREDF during fetal OSB repair did not negatively influence postnatal or 2-year neurodevelopmental outcomes. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- L Ruegg
- Department of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - L Vonzun
- Department of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - B Latal
- University of Zurich, Zurich, Switzerland
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - U Moehrlen
- University of Zurich, Zurich, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - L Mazzone
- University of Zurich, Zurich, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Meuli
- University of Zurich, Zurich, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - F Krähenmann
- Department of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - N Ochsenbein-Kölble
- Department of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| |
Collapse
|
5
|
Mikulski MF, Well A, Beckerman Z, Fraser CD, Bebbington MW, Moise KJ. Open and endoscopic fetal myelomeningocele surgeries display similar in-hospital safety profiles in a large, multi-institutional database. Am J Obstet Gynecol MFM 2023; 5:100854. [PMID: 36587805 DOI: 10.1016/j.ajogmf.2022.100854] [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] [Received: 11/28/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Open intrauterine fetal myelomeningocele repair has demonstrated decreased ventriculoperitoneal shunting and improved motor outcomes despite maternal and fetal risks. Few data directly compare the safety of open vs endoscopic approaches. OBJECTIVE This study aimed to analyze in-hospital maternal and fetal outcomes of pregnant patients undergoing open vs endoscopic fetal myelomeningocele repair using a large, multi-center database. STUDY DESIGN This was a review of the Pediatric Health Information System database from October 1, 2015, to December 31, 2021. All patients who underwent open or endoscopic fetal myelomeningocele repair according to the International Classification of Diseases, Tenth Revision, were identified. Demographics, gestational age, and outcomes were analyzed. Descriptive and univariate statistics were used. RESULTS A total of 378 pregnant patients underwent fetal myelomeningocele repair. The approach was endoscopic in 143 cases (37.8%) and open in 235 cases (62.2%). Overall postprocedural outcomes included no maternal in-hospital mortalities or intensive care unit admissions, a median length of stay of 4 days (interquartile range, 4-5), 14 cases (3.7%) of surgical and postoperative complications, 6 cases (1.6%) of intrauterine infections, 12 cases (3.2%) of obstetrical complications (including preterm premature rupture of membranes), 3 cases (0.8%) of intrauterine fetal demise, and 16 cases (4.2%) of preterm delivery. Compared with an open approach, the endoscopic approach occurred at a later gestational age (25 weeks [interquartile range, 24-25] vs 24 weeks [interquartile range, 24-25]; P<.001) and had an increased rate of intrauterine infection (6 [4.2%] cases vs 0 [0%] case; P=.002). There was no difference between approaches in the rates of surgical complications, obstetrical complications, intrauterine fetal demise, or preterm deliveries. CONCLUSION Compared with an open approach, endoscopic fetal myelomeningocele repair displays a comparable rate of fetal complications, including intrauterine fetal demise and preterm delivery, and a similar in-hospital maternal safety profile despite an association with increased intrauterine infection.
Collapse
Affiliation(s)
- Matthew F Mikulski
- Departments of Surgery and Perioperative Care (Drs Mikulski, Well, Beckerman, and Fraser).
| | - Andrew Well
- Departments of Surgery and Perioperative Care (Drs Mikulski, Well, Beckerman, and Fraser)
| | - Ziv Beckerman
- Departments of Surgery and Perioperative Care (Drs Mikulski, Well, Beckerman, and Fraser); Department of Surgery, Duke University School of Medicine, Durham NC (Dr Beckerman)
| | - Charles D Fraser
- Departments of Surgery and Perioperative Care (Drs Mikulski, Well, Beckerman, and Fraser)
| | - Michael W Bebbington
- Women's Health (Drs Bebbington and Moise), The University of Texas at Austin Dell Medical School, Austin, TX
| | - Kenneth J Moise
- Women's Health (Drs Bebbington and Moise), The University of Texas at Austin Dell Medical School, Austin, TX
| |
Collapse
|
6
|
Vonzun L, Gonser M, Moehrlen U, Mazzone L, Meuli M, Kandler L, Wille D, Kraehenmann F, Zimmermann R, Ochsenbein-Kölble N. M-Sign in Middle Cerebral Artery Doppler Waveforms: A Sign of Fetal Vasoconstriction Before and After Open Fetal Spina Bifida Repair. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:68-74. [PMID: 35135034 DOI: 10.1055/a-1722-2721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Increased pulse wave reflection in the fetal arterial system, illustrated by a second systolic peak (M-sign) in middle cerebral artery (MCA) Doppler waveforms, allows interpretation of fetal systemic vasoconstriction. Little is known about fetal vascular regulation during fetal spina bifida (fSB) repair. Therefore, the aim of this study was to analyze MCA-Doppler waveform changes before, during, and after fSB repair. PATIENTS AND METHODS 31 pregnant women who underwent fSB repair were included. Fetal MCA-Doppler waveforms were prospectively analyzed before, during and after fSB repair, and categorized as follows: normal systolic downslope, systolic shoulder, second systolic peak (M-sign), and concave systolic downslope. These MCA waveforms were related to maternal and fetal characteristics, to anesthetic medication, and to umbilical artery (UA) waveforms. RESULTS Before fSB repair, all fetuses repeatedly presented M-signs. After initiation of desflurane for general anesthesia, systolic shoulder and the M-sign vanished in 24/31 (78%) fetuses and 19/31 (61%) showed transient UA ARED flow. A significant association between these two Doppler findings was found (p=0.007). After fSB repair, signs of increased pulse wave reflection reappeared but resolved over time (23 days ± 20, SD) in all fetuses. CONCLUSION Both fSB and intrauterine repair influence fetal vascular regulation. This phenomenon can be illustrated by MCA-Doppler waveforms. While anesthetic agents transiently eliminated M-signs and often provoked a UA ARED flow, fSB repair finally led to normalization of MCA-Doppler waveforms indicating return to normal fetal vascular regulation.
Collapse
Affiliation(s)
- Ladina Vonzun
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Markus Gonser
- Obsterics and Prenatal Medicine, HELIOS HSK Wiesbaden, Wiesbaden, Germany
| | - Ueli Moehrlen
- Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Luca Mazzone
- Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Martin Meuli
- Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Lukas Kandler
- Anesthiesiology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - David Wille
- Department of Pediatric Neurology, Baden Cantonal Hospital, Baden, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Franziska Kraehenmann
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Roland Zimmermann
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
7
|
Zamłyński M, Olejek A, Horzelska E, Horzelski T, Zamłyński J, Bablok R, Maruniak-Chudek I, Olszak-Wąsik K, Pastuszka A. Decreased Maternal Morbidity and Improved Perinatal Results of Magnesium-Free Tocolysis and Classical Hysterotomy in Fetal Open Surgery for Myelomeningocele Repair: A Single-Center Study. Biomedicines 2023; 11:biomedicines11020392. [PMID: 36830929 PMCID: PMC9953469 DOI: 10.3390/biomedicines11020392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
Fetal and maternal risks associated with open fetal surgery (OFS) in the management of meningomyelocele (MMC) are considerable and necessitate improvement. A modified technique of hysterotomy (without a uterine stapler) and magnesium-free tocolysis (with Sevoflurane as the only uterine muscle relaxant) was implemented in our new magnesium-free tocolysis and classical hysterotomy (MgFTCH) protocol. The aim of the study was to assess the introduction of the MgFTCH protocol in reducing maternal and fetal complications. The prospective study cohort (SC) included 64 OFS performed with MgFTCH at the Fetal Surgery Centre Bytom (FSCB) (2015-2020). Fetal and maternal outcomes were compared with the retrospective cohort (RC; n = 46), and data from the Zurich Center for Fetal Diagnosis and Therapy (ZCFDT; n = 40) and the Children's Hospital of Philadelphia (CHOP; n = 100), all using traditional tocolysis. The analysis included five major perinatal complications (Clavien-Dindo classification, C-Dc) which developed before the end of 34 weeks of gestation (GA, gestational age). None of the newborns was delivered before 30 GA. Only two women presented with grade 3 complications and none with 4th or 5th grade (C-Dc). The incidence of perinatal death (3.3%) was comparable with the RC (4.3%) and CHOP data (6.1%). MgFTCH lowers the risk of major maternal and fetal complications.
Collapse
Affiliation(s)
- Mateusz Zamłyński
- Department of Gynecology, Obstetrics and Oncological Gynecology, Bytom, Medical University of Silesia, 41-902 Katowice, Poland
- Correspondence:
| | - Anita Olejek
- Department of Gynecology, Obstetrics and Oncological Gynecology, Bytom, Medical University of Silesia, 41-902 Katowice, Poland
| | - Ewa Horzelska
- Department of Gynecology, Obstetrics and Oncological Gynecology, Bytom, Medical University of Silesia, 41-902 Katowice, Poland
| | - Tomasz Horzelski
- Department of Gynecology, Obstetrics and Oncological Gynecology, Bytom, Medical University of Silesia, 41-902 Katowice, Poland
| | - Jacek Zamłyński
- Department of Gynecology, Obstetrics and Oncological Gynecology, Bytom, Medical University of Silesia, 41-902 Katowice, Poland
| | - Rafał Bablok
- Department of Gynecology, Obstetrics and Oncological Gynecology, Bytom, Medical University of Silesia, 41-902 Katowice, Poland
| | - Iwona Maruniak-Chudek
- Department of Neonatology and Neonatal Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Katarzyna Olszak-Wąsik
- Department of Gynecology, Obstetrics and Oncological Gynecology, Bytom, Medical University of Silesia, 41-902 Katowice, Poland
| | - Agnieszka Pastuszka
- Department of Gynecology, Obstetrics and Oncological Gynecology, Bytom, Medical University of Silesia, 41-902 Katowice, Poland
- Department of Pediatric Surgery and Urology Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| |
Collapse
|
8
|
Are Cervical Length and Fibronectin Predictors of Preterm Birth after Fetal Spina Bifida Repair? A Single Center Cohort Study. J Clin Med 2022; 12:jcm12010123. [PMID: 36614924 PMCID: PMC9821246 DOI: 10.3390/jcm12010123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Background: A remaining risk of fetal spina bifida (fSB) repair is preterm delivery. This study assessed the value of preoperative cervical length (CL), CL dynamics (∆CL) and fetal fibronectin (fFN) tests to predict obstetric complications and length of stay (LOS) around fSB repair. Methods: 134 patients were included in this study. All patients had CL measurement and fFN testing before fSB repair. ∆CL within the first 14 days after intervention and until discharge after fSB repair were compared in groups (∆CL ≥ 10 mm/<10 mm; ≥20 mm/<20 mm). CL before surgery, ∆CL’s, and positive fFN tests were correlated to obstetric complications and LOS. Results: Mean CL before surgery was 41 ± 7 mm. Mean GA at birth was 35.4 ± 2.2 weeks. In the group of ∆CL ≥ 10 mm within the first 14 days after intervention, LOS was significantly longer (p = 0.02). ∆CL ≥ 10 mm until discharge after fSB was associated with a significantly higher rate of GA at birth <34 weeks (p = 0.03). The 3 positive fFN tests before fSB repair showed no correlation with GA at birth. Conclusion: Perioperative ∆CL influences LOS after fetal surgery. ∆CL ≥ 10 mm until discharge after fSB repair has a 3-times higher rate of preterm delivery before 34 weeks. Preoperative fFN testing showed no predictive value for preterm birth after fSB repair and was stopped.
Collapse
|
9
|
Marquart JP, Foy AB, Wagner AJ. Controversies in Fetal Surgery: Prenatal Repair of Myelomeningocele in the Modern Era. Clin Perinatol 2022; 49:267-277. [PMID: 35210005 DOI: 10.1016/j.clp.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Fetal surgery is a constantly evolving field that showed noticeable progress with the treatment of myelomeningocele (MMC) using prenatal repair. Despite this success, there are ongoing questions regarding the optimal approach for fetal myelomeningocele repair, as well as which patients are eligible. Expansion of the inclusion and exclusion criteria is an important ongoing area of study for myelomeningocele including the recent Management of Myelomeningocele Plus trial. The significant personal and financial burden required of families seeking treatment has likely limited its accessibility to the general population.
Collapse
Affiliation(s)
- John P Marquart
- Children's Wisconsin, 999 North 92nd Street, Suite C320, Milwaukee, WI 53226, USA
| | - Andrew B Foy
- Department of Pediatric Neurosurgery, Children's Wisconsin, 8915 W. Connell Court, Milwaukee, WI 53226, USA
| | - Amy J Wagner
- Division of Pediatric Surgery, Children's Wisconsin, 999 North 92nd Street, Suite C320, Milwaukee, WI 53226, USA.
| |
Collapse
|
10
|
Sosa C, Rivas M, Mascareño P, Amarilla L, Ricardo A, Rojas M, Gonzalez J, Sosa P. Outcome of fetal microneurosurgery for intrauterine spina bifida repair in country with deficient healthcare system. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:120-122. [PMID: 34255893 DOI: 10.1002/uog.23738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/26/2021] [Accepted: 07/02/2021] [Indexed: 06/13/2023]
Affiliation(s)
- C Sosa
- Fundación Fetosur, Medicina Materno Fetal y Cirugía Fetal, Sanatorio Internacional, Ciudad del Este, Paraguay
- Unidad de Cirugía Experimental, Instituto Venezolano de Investigaciones Científicas, Altos de Pipe, Caracas, Venezuela
| | - M Rivas
- Departamento de Neurocirugía Pediátrica, Hospital de Clínicas, Facultad de Medicina, Universidad Nacional de Asunción, Asunción, Paraguay
| | - P Mascareño
- Fundación Fetosur, Medicina Materno Fetal y Cirugía Fetal, Sanatorio Internacional, Ciudad del Este, Paraguay
| | - L Amarilla
- Fundación Fetosur, Medicina Materno Fetal y Cirugía Fetal, Sanatorio Internacional, Ciudad del Este, Paraguay
| | - A Ricardo
- Fundación Fetosur, Medicina Materno Fetal y Cirugía Fetal, Sanatorio Internacional, Ciudad del Este, Paraguay
| | - M Rojas
- Fundación Fetosur, Medicina Materno Fetal y Cirugía Fetal, Sanatorio Internacional, Ciudad del Este, Paraguay
| | - J Gonzalez
- Departamento de Neurocirugía Pediátrica, Hospital de Clínicas, Facultad de Medicina, Universidad Nacional de Asunción, Asunción, Paraguay
| | - P Sosa
- Fundación Fetosur, Medicina Materno Fetal y Cirugía Fetal, Sanatorio Internacional, Ciudad del Este, Paraguay
| |
Collapse
|
11
|
Lillegard JB, Eyerly-Webb SA, Watson DA, Bahtiyar MO, Bennett KA, Emery SP, Fisher AJ, Goldstein RB, Goodnight WH, Lim FY, McCullough LB, Moehrlen U, Moldenhauer JS, Moon-Grady AJ, Ruano R, Skupski DW, Treadwell MC, Tsao K, Wagner AJ, Zaretsky MV. Placental Location in Maternal-Fetal Surgery for Myelomeningocele. Fetal Diagn Ther 2021; 49:117-124. [PMID: 34915495 DOI: 10.1159/000521379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Uterine incision based on placental location in open maternal-fetal surgery (OMFS) has never been evaluated in regards to maternal or fetal outcomes. OBJECTIVE To investigate whether an anterior placenta was associated with increased rates of intraoperative, perioperative, antepartum, obstetric, or neonatal complications in mothers and babies who underwent OMFS for myelomeningocele (fMMC) closure. METHODS Data from the international multi-center prospective registry of patients who underwent OMFS for fMMC closure (fMMC Consortium Registry, 12/15/2010-7/31/2019) was used to compare fetal and maternal outcomes between anterior and posterior placental locations. RESULTS Placental location for 623 patients was evenly distributed between anterior (51%) or posterior (49%). Intraoperative fetal bradycardia (8.3% vs 3.0%, p=0.005) and performance of fetal resuscitation (3.6% vs 1.0%, p=0.034) occurred more frequently in cases with an anterior placenta when compared to those with a posterior placenta. Obstetric outcomes including membrane separation, placental abruption, and spontaneous rupture of membranes were not different among the two groups. However, thinning of the hysterotomy site (27.7% vs 17.7%, p=0.008) occurred more frequently in cases of anterior placenta. Gestational age at delivery (p=0.583) and length of stay in the neonatal intensive care unit (p=0.655) were similar between the two groups. Fetal incision dehiscence and wound revision were not significantly different between groups. Critical clinical outcomes including fetal demise, perinatal death, and neonatal death were all infrequent occurrences and not associated with placental location. CONCLUSIONS Anterior placental location is associated with increased risk of intraoperative fetal resuscitation and increased thinning at the hysterotomy closure site. Individual institutional experiences may have varied but the aggregate data from the fMMC Consortium did not show a significant impact on the gestational age at delivery or maternal or fetal clinical outcomes.
Collapse
Affiliation(s)
- Joseph B Lillegard
- Midwest Fetal Care Center, Children's Minnesota, Minneapolis, Minnesota, USA
- Division of General Surgery Research, Mayo Clinic, Rochester, Minnesota, USA
- Pediatric Surgical Associates, Minneapolis, Minnesota, USA
| | | | - David A Watson
- Research Design and Analytics, Children's Minnesota, Minneapolis, Minnesota, USA
| | | | | | | | | | - Ruth B Goldstein
- University of California San Francisco, San Francisco, California, USA
| | - William H Goodnight
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Foong-Yen Lim
- Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | | | | | | | | | - Rodrigo Ruano
- University of Texas Health Science Center, Houston, Texas, USA
| | | | | | - KuoJen Tsao
- University of Texas Health Science Center, Houston, Texas, USA
| | - Amy J Wagner
- Children's Hospital of Wisconsin Fetal Concerns Center, Milwaukee, Wisconsin, USA
| | | |
Collapse
|
12
|
Vonzun L, Winder FM, Meuli M, Moehrlen U, Mazzone L, Kraehenmann F, Huesler M, Zimmermann R, Ochsenbein-Kölble N. Hindbrain Herniation and Banana and Lemon Sign After Open Fetal Myelomeningocele Repair - When Do These Signs Disappear and is Shunting Predictable? ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:514-519. [PMID: 32330995 DOI: 10.1055/a-1112-7096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE The aim was to describe the sonographic follow-up of hindbrain herniation (HH), the banana and lemon sign after fetal myelomeningocele (fMMC) repair, and the time of disappearance of these signs after the intervention, and to investigate any predictive value for the necessity of shunting during the infant's first year of life. Additionally, the sonographic evolution of the transcerebellar diameter (TCD) before and after fetal intervention was assessed. PATIENTS AND METHODS The first 50 patients that underwent fMMC repair at Zurich Center for Fetal Diagnosis and Therapy (www.swissfetus.ch) were included in this study. Sonographic scans performed weekly after fMMC repair focusing on HH and banana and lemon signs were analyzed and compared between the shunted and the non-shunted group. ROC curves were generated for the time intervals of resolution of the signs in order to show their predictive accuracy for the need for shunting until 1 year of age. RESULTS HH resolved in 48 fetuses (96 %) before delivery. The sonographic disappearance of HH within the first two weeks after fMMC repair was associated with a significantly lower incidence of shunt placement (OR 0.19; 95 % CI 0.4-0.9) during the first year of life (p = 0.03). All fetuses with persistent HH before delivery received a shunt. TCD growth was observed in all fetuses. CONCLUSION The reversibility of HH within two weeks after fMMC repair is associated with an 80 % lower incidence of shunt placement during the infant's first year of life. Moreover, it allows the cerebellum to grow and to normalize its configuration.
Collapse
Affiliation(s)
- Ladina Vonzun
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | | | - Martin Meuli
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- University Children's Hospital Zurich, Spina-Bifida-Center, Zurich, Switzerland
| | - Ueli Moehrlen
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- University Children's Hospital Zurich, Spina-Bifida-Center, Zurich, Switzerland
| | - Luca Mazzone
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- University Children's Hospital Zurich, Spina-Bifida-Center, Zurich, Switzerland
| | - Franziska Kraehenmann
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Margaret Huesler
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Roland Zimmermann
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
13
|
Cruz-Martínez R, Gámez-Varela A, Cruz-Lemini M, Martínez-Rodríguez M, Luna-García J, López-Briones H, Chavelas-Ochoa F, Chávez-González E, Aguilar-Vidales K, Chávez-Vega J, Castelo-Vargas A, Rivera-Carrillo P, Hernández-Andrade E. Doppler changes in umbilical artery, middle cerebral artery, cerebroplacental ratio and ductus venosus during open fetal microneurosurgery for intrauterine open spina bifida repair. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:238-244. [PMID: 32798234 DOI: 10.1002/uog.22177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To describe changes in fetal Doppler parameters during a novel technique for open fetal microneurosurgery for open spina bifida (OSB) repair. METHODS This was a prospective study of 44 fetuses undergoing open fetal surgery for OSB repair using a novel microneurosurgery approach that is characterized by a mini-hysterotomy (diameter of 15 mm), minimal fetal manipulation and maintenance of a constant normal amniotic fluid volume throughout the procedure. Doppler velocimetry of the umbilical artery (UA), fetal middle cerebral artery (MCA) and ductus venosus (DV) was performed before the start of surgery and at prespecified timepoints during fetal surgery. UA pulsatility index (PI) > 95th percentile, DV-PI > 95th percentile, MCA-PI < 5th percentile and cerebroplacental ratio (CPR) < 5th percentile were considered abnormal. RESULTS Median gestational age at fetal surgery was 25.2 weeks (range, 22.9-27.9 weeks). Doppler recordings were successfully obtained in all cases during all timepoints throughout the surgery. As compared with Doppler values before surgery, there was a significant increase in the proportion of fetuses with MCA-PI < 5th percentile (63.6% vs 13.6%; P < 0.001), CPR < 5th percentile (65.9% vs 15.9%; P < 0.001) and DV-PI > 95th percentile (22.7% vs 0%; P = 0.01) and a non-significant increase in the proportion of fetuses with UA-PI > 95th percentile (11.4% vs 0%; P = 0.12) during fetal surgery. None of the fetuses showed absent or reversed end-diastolic velocity in the UA or absent or reversed DV a-wave at any stage during OSB repair. All abnormal Doppler parameters returned to normal after surgery. CONCLUSIONS During open fetal surgery for OSB repair, a small hysterotomy, reduced fetal manipulation and maintenance of a normal amniotic fluid volume seem to prevent severe fetal Doppler abnormalities. The mild Doppler changes observed during fetal surgery could be a manifestation of fetal adaptation to the stress of fetal surgery. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- R Cruz-Martínez
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
- Instituto de Ciencias de la Salud (ICSa), Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico
| | - A Gámez-Varela
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
| | - M Cruz-Lemini
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
| | - M Martínez-Rodríguez
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
- Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez Lara", Querétaro, Mexico
| | - J Luna-García
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
| | - H López-Briones
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
| | - F Chavelas-Ochoa
- Department of Neurosurgery, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez Lara", Querétaro, Mexico
| | - E Chávez-González
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
| | - K Aguilar-Vidales
- Department of Anesthesiology, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez Lara", Querétaro, Mexico
| | - J Chávez-Vega
- Department of Anesthesiology, Hospital de Especialidades del Niño y la Mujer "Dr. Felipe Núñez Lara", Querétaro, Mexico
| | - A Castelo-Vargas
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
| | - P Rivera-Carrillo
- Fetal Medicine and Surgery Center, Medicina Fetal México, Querétaro, Mexico
| | - E Hernández-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| |
Collapse
|
14
|
da Rocha LSN, Bunduki V, de Amorim Filho AG, Cardeal DD, Matushita H, Fernandes HS, Nani FS, de Francisco RPV, de Carvalho MHB. Open fetal myelomeningocele repair at a university hospital: surgery and pregnancy outcomes. Arch Gynecol Obstet 2021; 304:1443-1454. [PMID: 33932174 DOI: 10.1007/s00404-021-06066-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Myelomeningocele (MMC) is an open neural tube defect that causes great morbidity. Prenatal open repair is the standard treatment; however, there are many complications related to the procedure. This study reports preliminary findings of open in utero repair of MMC in a public tertiary hospital in Brazil and describes factors that could be associated with increased surgical morbidity. METHODS Thirty-nine patients underwent open in utero repair of MMC from October 2015 to August 2019. The Clavien-Dindo classification of surgical complications and a classification system with the preterm definitions of the World Health Organization were used, respectively, for maternal and fetal complications. RESULTS A total of 28 mothers (71.8%) and 31 fetuses (79.5%) experienced at least one minor to major complication. Three mothers (7.7%) had a severe grade 4 complication. Fetal complications grades 3 to 5 occurred in 13 fetuses (33.3%). Gestational age at surgery and at birth were 24.88 ± 1.16 weeks and 33.23 ± 3.68 weeks, respectively. Preterm delivery occurred in 30 patients (76.9%), membrane rupture in 18 patients (46.2%) and chorioamnionitis in 13 patients (33.3%). CONCLUSION Open fetal surgery for MMC was performed at a Brazilian public tertiary care center, resulting in three grade 4 maternal complications. Relevant fetal complications were also present. The use of a standard classification system for complications renders studies more comparable and data more useful for counseling patients. Adjustments of perioperative procedures and long-term follow-up are needed to determine the real benefit of open in utero repair of MMC at our hospital.
Collapse
Affiliation(s)
- Luana Sarmento Neves da Rocha
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255 - 10° andar - Cerqueira Cesar, Sao Paulo, CEP 05403-000, Brazil
| | - Victor Bunduki
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255 - 10° andar - Cerqueira Cesar, Sao Paulo, CEP 05403-000, Brazil
| | - Antônio Gomes de Amorim Filho
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255 - 10° andar - Cerqueira Cesar, Sao Paulo, CEP 05403-000, Brazil
| | - Daniel Dante Cardeal
- Disciplina de Neurocirurgia, Departamento de Neurologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR, Brazil
| | - Hamilton Matushita
- Disciplina de Neurocirurgia, Departamento de Neurologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR, Brazil
| | - Hermann Santos Fernandes
- Disciplina de Anestesiologia, Departamento de Cirurgia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR, Brazil
| | - Fernando Souza Nani
- Disciplina de Anestesiologia, Departamento de Cirurgia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR, Brazil
| | - Rossana Pulcineli Vieira de Francisco
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255 - 10° andar - Cerqueira Cesar, Sao Paulo, CEP 05403-000, Brazil
| | - Mário Henrique Burlacchini de Carvalho
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255 - 10° andar - Cerqueira Cesar, Sao Paulo, CEP 05403-000, Brazil.
| |
Collapse
|
15
|
Cruz-Martínez R, Chavelas-Ochoa F, Martínez-Rodríguez M, Aguilar-Vidales K, Gámez-Varela A, Luna-García J, López-Briones H, Chávez-Vega J, Pérez-Calatayud ÁA, Díaz-Carrillo MA, Ahumada-Angulo E, Castelo-Vargas A, Chávez-González E, Juárez-Martínez I, Villalobos-Gómez R, Rebolledo-Fernández C. Open Fetal Microneurosurgery for Intrauterine Spina Bifida Repair. Fetal Diagn Ther 2021; 48:163-173. [PMID: 33582666 DOI: 10.1159/000513311] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of the study was to describe the feasibility of open fetal microneurosurgery for intrauterine spina bifida (SB) repair and to compare perinatal outcomes with cases managed using the classic open fetal surgery technique. METHODS In this study, we selected a cohort of consecutive fetuses with isolated open SB referred to our fetal surgery center in Queretaro, Mexico, during a 3.5-year period (2016-2020). SB repair was performed by either classic open surgery (6- to 8-cm hysterotomy with leakage of amniotic fluid, which was replaced before uterine closure) or open microneurosurgery, which is a novel technique characterized by a 15- to 20-mm hysterotomy diameter, reduced fetal manipulation by fixing the fetal back, and maintenance of normal amniotic fluid and uterine volume during the whole surgery. Perinatal outcomes of cases operated with the classic open fetal surgery technique and open microneurosurgery were compared. RESULTS Intrauterine SB repair with a complete 3-layer correction was successfully performed in 60 cases either by classic open fetal surgery (n = 13) or open microneurosurgery (n = 47). No significant differences were observed in gestational age (GA) at fetal intervention (25.4 vs. 25.1 weeks, p = 0.38) or surgical times (107 vs. 120 min, p = 0.15) between both groups. The group with open microneurosurgery showed a significantly lower rate of oligohydramnios (0 vs. 15.4%, p = 0.01), preterm rupture of the membranes (19.0 vs. 53.8%, p = 0.01), higher GA at birth (35.1 vs. 32.7 weeks, p = 0.03), lower rate of preterm delivery <34 weeks (21.4 vs. 61.5%, p = 0.01), and lower rate of perinatal death (4.8 vs. 23.1%, p = 0.04) than the group with classic open surgery. During infant follow-up, the rate of hydrocephalus requiring ventriculoperitoneal shunting was similar between both groups (7.5 vs. 20%, p = 0.24). All patients showed an intact hysterotomy site at delivery. CONCLUSION Intrauterine spina repair by open fetal microneurosurgery is feasible and was associated with better perinatal outcomes than classic open fetal surgery.
Collapse
Affiliation(s)
- Rogelio Cruz-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico, .,Instituto de Ciencias de la Salud (ICSa) , Universidad Autónoma del Estado de Hidalgo (UAEH), Hidalgo, Mexico, .,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico,
| | - Felipe Chavelas-Ochoa
- Department of Pediatric Neurosurgery, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico
| | - Miguel Martínez-Rodríguez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico.,Department of Fetal Surgery, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico
| | - Karla Aguilar-Vidales
- Department of Anesthesiology, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico
| | - Alma Gámez-Varela
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Jonahtan Luna-García
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Hugo López-Briones
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Joel Chávez-Vega
- Department of Anesthesiology, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico
| | - Ángel Augusto Pérez-Calatayud
- Department of Maternal Intensive Care, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico
| | - Manuel Alejandro Díaz-Carrillo
- Department of Maternal Intensive Care, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico
| | - Edgar Ahumada-Angulo
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Andrea Castelo-Vargas
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Eréndira Chávez-González
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Israel Juárez-Martínez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Rosa Villalobos-Gómez
- Prenatal Diagnosis and Fetal Surgery Center, Fetal Medicine Mexico and the Fetal Medicine Foundation of Mexico, Queretaro, Mexico
| | - Carlos Rebolledo-Fernández
- Department of Maternal Fetal Medicine, Hospital de Especialidades del Niño y la Mujer Dr. Felipe Núñez Lara, Queretaro, Mexico
| |
Collapse
|
16
|
Vonzun L, Kahr MK, Noll F, Mazzone L, Moehrlen U, Meuli M, Hüsler M, Krähenmann F, Zimmermann R, Ochsenbein-Kölble N. Systematic classification of maternal and fetal intervention-related complications following open fetal myelomeningocele repair - results from a large prospective cohort. BJOG 2020; 128:1184-1191. [PMID: 33152167 DOI: 10.1111/1471-0528.16593] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To systematically categorise all maternal and fetal intervention-related complications after open fetal myelomeningocele (fMMC) repair of the first 124 cases operated at the Zurich Centre for Fetal Diagnosis and Therapy. DESIGN A prospective cohort study. SETTING Single centre. POPULATION Mothers and fetuses after fMMC repair. METHODS Between 2010 and 2019, we collected and entered all maternal complications following fMMC repair into the Clavien-Dindo classification. For fetal complications, a classification system based on the Medical Dictionary for Regulatory Activities terminology of Adverse Events was used including the preterm definitions of the World Health Organization. MAIN OUTCOME MEASURES Systematic classification of maternal and fetal complications following fMMC repair. RESULTS Gestational ages at surgery and birth were 25.0 ± 0.8 and 35.4 ± 2.0 weeks, respectively. In 17% of all cases, no maternal complications occurred. Maternal intervention-related complications were observed as follows: 69% grade 1, 36% grade 2, 25% grade 3, 6% grade 4 and 0% grade 5. In 34%, no fetal complications were noted; however, 43% of the fetuses developed a grade 1, 14% a grade 2, 8% a grade 3, 2% a grade 4 and 2% a grade 5 complication. CONCLUSION This study raises awareness of complications following open fMMC repair; 6% of mothers and 2% of fetuses experienced a severe complication (grade 4) and perinatal death rate of 2% was observed (grade 5). These data are useful for prenatal counselling, they help to improve the system of fetal surgical care, and they allow benchmarking with other centres as well as comparison with fetoscopic approaches. TWEETABLE ABSTRACT Systematic classification of all maternal and fetal intervention-related complications following open fMMC repair.
Collapse
Affiliation(s)
- L Vonzun
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland.,The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - M K Kahr
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - F Noll
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - L Mazzone
- The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland.,Department of Paediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Spina Bifida Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - U Moehrlen
- The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland.,Department of Paediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Spina Bifida Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Meuli
- The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland.,Department of Paediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Spina Bifida Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Hüsler
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland.,The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - F Krähenmann
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland.,The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - R Zimmermann
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland.,The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - N Ochsenbein-Kölble
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland.,The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| |
Collapse
|
17
|
Sepulveda W, Corral E, Alcalde JL, Otayza F, Müller JM, Ravera F, Devoto JC, Tapia M. Prenatal Repair of Spina Bifida: A 2-Center Experience with Open Intrauterine Neurosurgery in Chile. Fetal Diagn Ther 2020; 47:873-881. [PMID: 32937625 DOI: 10.1159/000509242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 06/06/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report the experience with prenatal repair of open spina bifida (OSB) from 2 centers in Chile. METHODS Women with a second-trimester fetus with OSB were offered intrauterine neurosurgical repair following the protocol from the Management of Myelomeningocele Study (MOMS) trial. Pediatric follow-up with infants reaching 12 and 30 months of life was also reviewed. RESULTS Fifty-eight fetuses with OSB underwent intrauterine repair at an average (±SD) gestational age of 24.8 ± 0.9 weeks. There were 3 (5.1%) intrauterine deaths. The average gestational age at delivery of the remaining 55 cases was 33.3 ± 3.6 weeks, and the average birth weight was 2,172 ± 751 g. Delivery before 30 weeks occurred in 11 cases (20.0%). Two (3.6%) neonatal deaths (<28 days) occurred. At 12 months, a ventriculoperitoneal shunt or an endoscopic third ventriculostomy was required in 25% of the cases. At 30 months, 72.4% of the infants were able to walk. DISCUSSION Prenatal neurosurgical repair of OSB is a complex and challenging intervention. Major complications include perinatal death and severe prematurity. No major maternal complications occurred in our series. A reduction in the need for cerebrospinal fluid diversion and an improved ability to walk seem to be the greatest long-term advantages of this procedure.
Collapse
Affiliation(s)
- Waldo Sepulveda
- Fetal Surgery Program, Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile, .,Fetal Imaging Unit, FETALMED Maternal-Fetal Diagnostic Center, Santiago, Chile,
| | - Edgardo Corral
- Department of Obstetrics and Gynecology, Regional Hospital, Rancagua, Chile
| | - Juan L Alcalde
- Fetal Surgery Program, Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile
| | - Felipe Otayza
- Department of Neurosurgery, Clinica Las Condes, Santiago, Chile
| | - Jose M Müller
- Department of Neurosurgery, Regional Hospital, Rancagua, Chile
| | - Franco Ravera
- Department of Neurosurgery, Regional Hospital, Rancagua, Chile
| | - Juan C Devoto
- Department of Anesthesiology, Clinica Las Condes, Santiago, Chile
| | - Mirta Tapia
- Department of Anesthesiology, Regional Hospital, Rancagua, Chile
| |
Collapse
|
18
|
Ghidini A, Bianchi DW, Levy B, Van Mieghem T, Deprest J, Chitty LS. In case you missed it: The prenatal diagnosis editors bring you the most significant advances of 2018. Prenat Diagn 2019; 39:61-69. [PMID: 30593668 DOI: 10.1002/pd.5407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Alessandro Ghidini
- Antenatal Testing Center Alexandria Hospital, Alexandria, VA, USA.,Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, D.C., USA
| | - Diana W Bianchi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Brynn Levy
- Departments of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Tim Van Mieghem
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Jan Deprest
- Departments of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Lyn S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| |
Collapse
|