Minimally invasive fetal surgery for myelomeningocele: preliminary report from a single center
| Autor: | Claudia Cinnante, Giuliana Anna Porro, Nicola Persico, Giulio Bertani, Lorenzo Gabetta, Paolo Rampini, Fabrizio Ciralli, Simona Boito, Ernesto Leva, Giulia Meccariello, Rolando Campanella, Isabella Fabietti, Fabio Triulzi, Odoardo Picciolini, Francesco Macchini, Luigi Schisano, Fabio Mosca, D. A. Lapa, Marco Locatelli, Giorgio Carrabba |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
medicine.medical_specialty Meningomyelocele medicine.medical_treatment Physical examination Gestational Age Fetoscopy 03 medical and health sciences 0302 clinical medicine Pregnancy medicine Humans Minimally Invasive Surgical Procedures medicine.diagnostic_test Spina bifida business.industry Fetal surgery Infant Newborn Gestational age General Medicine medicine.disease Hydrocephalus Surgery Treatment Outcome 030220 oncology & carcinogenesis Female Neurology (clinical) business Complication 030217 neurology & neurosurgery Ventriculomegaly |
| Zdroj: | Neurosurgical focus. 47(4) |
| ISSN: | 1092-0684 |
| Popis: | OBJECTIVERecent trials have shown the safety and benefits of fetoscopic treatment of myelomeningocele (MMC). The authors’ aim was to report their preliminary results of prenatal fetoscopic treatment of MMC using a biocellulose patch, focusing on neurological outcomes, fetal and maternal complications, neonatal CSF leakage, postnatal hydrocephalus, and radiological outcomes.METHODSPreoperative assessment included clinical examination, ultrasound imaging, and MRI of the fetus. Patients underwent purely fetoscopic in utero MMC repair, followed by postoperative in utero and postnatal MRI. All participants received multidisciplinary follow-up.RESULTSFive pregnant women carrying fetuses affected by MMC signed informed consent for the fetoscopic treatment of the defect. The mean MMC size was 30.4 mm (range 19–49 mm). Defect locations were L1 (2 cases), L5 (2 cases), and L4 (1 case). Hindbrain herniation and ventriculomegaly were documented in all cases. The mean gestational age at surgery was 28.2 weeks (range 27.8–28.8 weeks). Fetoscopic repair was performed in all cases. The mean gestational age at delivery was 33.9 weeks (range 29.3–37.4 weeks). After surgery, reversal of hindbrain herniation was documented in all cases. Three newborns developed signs of hydrocephalus requiring CSF diversion. Neurological outcomes in terms of motor level were favorable in all cases, but a premature newborn died due to CSF infection and sepsis.CONCLUSIONSThe authors’ preliminary results suggest that fetoscopic treatment of MMC is feasible, reproducible, and safe for mothers and their babies. Neurological outcomes were favorable and similar to those in the available literature. As known, prematurity was the greatest complication. |
| Databáze: | OpenAIRE |
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