Single-Access Fetal Endoscopy (SAFE) for myelomeningocele in sheep model I: amniotic carbon dioxide gas approach

详细信息    查看全文

• 作者：Jose L. Peiro (1)
  Cesar G. Fontecha (1)
  Rodrigo Ruano (2)
  Marielle Esteves (1)
  Carla Fonseca (1)
  Mario Marotta (1)
  Sina Haeri (2)
  Michael A. Belfort (2)
  
• 关键词：Animal model ; Fetal surgery ; Fetoscopy ; Myelomeningocele ; Single access ; Spina bifida
• 刊名：Surgical Endoscopy
• 出版年：2013
• 出版时间：October 2013
• 年：2013
• 卷：27
• 期：10
• 页码：3835-3840
• 全文大小：421KB
• 参考文献：1. Au KS, Ashley-Koch A, Northrup H (2010) Epidemiologic and genetic aspects of spina bifida and other neural tube defects. Dev Disabil Res Rev 16:6鈥?5 CrossRef
  2. Amari F, Junkers W, Hartge D, Beyer DA, Axt-Fliedner R, Weichert J (2010) Prenatal course and outcome in 103 cases of fetal spina bifida: a single-center experience. Acta Obstet Gynecol Scand 89:1276鈥?283 CrossRef
  3. Adzick NS (2010) Fetal myelomeningocele: natural history, pathophysiology, and in utero intervention. Semin Fetal Neonatal Med 15:9鈥?4 CrossRef
  4. Adzick NS, Thom EA, Spong CY, Brock JW III, Burrows PK, Johnson MP, Howell LJ, Farrell JA, Dabrowiak ME, Sutton LN, Gupta N, Tulipan NB, D鈥橝lton ME, Farmer DL, MOMS Investigators (2011) A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 364:993鈥?004 CrossRef
  5. Fontecha CG, Peiro JL, Aguirre M, Soldado F, A帽or S, Fresno L, Martinez-Iba帽ez V (2009) Inert patch with bioadhesive for gentle fetal surgery of myelomeningocele in a sheep model. Eur J Obstet Gynecol Reprod Biol 146:174鈥?79 CrossRef
  6. Fontecha CG, Peiro JL, Sevilla JJ, Aguirre M, Soldado F, Fresno L, Fonseca C, Chacaltana A, Martinez V (2011) Fetoscopic coverage of experimental myelomeningocele in sheep using a patch with surgical sealant. Eur J Obstet Gynecol Reprod Biol 156:171鈥?76 CrossRef
  7. Pedreira DA, Sanchez-Oliveira RC, Valente PR, Abou-Jamra RC, Araujo A, Saldiva PH (2007) Validation of the ovine fetus as an experimental model for the human myelomeningocele defect. Acta Cir Bras 22:168鈥?73 CrossRef
  8. Kohl T, Tchatcheva K, Merz W, Wartenberg HC, Heep A, M眉ller A, Franz A, Stressig R, Willinek W, Gembruch U (2009) Percutaneous fetoscopic patch closure of human spina bifida aperta: advances in fetal surgical techniques may obviate the need for early postnatal neurosurgical intervention. Surg Endosc 23:890鈥?95 CrossRef
  9. Copeland ML, Bruner JP, Richards WO, Sundell HW, Tulipan NB (1993) A model for in utero endoscopic treatment of myelomeningocele. Neurosurgery 33:542鈥?44 CrossRef
  10. Bruner JP, Richards WO, Tulipan NB, Arney TL (1999) Endoscopic coverage of fetal myelomeningocele in utero. Am J Obstet Gynecol 180(1 Pt 1):153鈥?58 CrossRef
  11. Bruner JP, Tulipan NB, Richards WO, Walsh WF, Boehm FH, Vrabcak EK (2000) In utero repair of myelomeningocele: a comparison of endoscopy and hysterotomy. Fetal Diagn Ther 15:83鈥?8 CrossRef
  12. Encinas JL, Garc铆a-Cabezas MA, Barkovich J, Fontecha CG, Peir贸 JL, Soto GM, Borrell V, Reillo I, L贸pez-Santamar铆a M, Tovar JA, Farmer DL (2011) Maldevelopment of the cerebral cortex in the surgically induced model of myelomeningocele: implications for fetal neurosurgery. J Pediatr Surg 46:713鈥?22 CrossRef
  13. Peir贸 JL, Encinas JL (2012) Fetal surgery of myelomeningocele: from experimental results to clinical evidence. Cir Pediatr 25:1鈥?
  14. Kohl T (2010) Minimally invasive fetoscopic interventions: an overview in 2010. Surg Endosc 24:2056鈥?067 CrossRef
  
• 作者单位：Jose L. Peiro (1)
  Cesar G. Fontecha (1)
  Rodrigo Ruano (2)
  Marielle Esteves (1)
  Carla Fonseca (1)
  Mario Marotta (1)
  Sina Haeri (2)
  Michael A. Belfort (2)
  
  1. Fetal Surgery Program, Congenital Malformations Research Group, Research Institute of Hospital Universitari Vall d鈥橦ebron, Edifici Infantil, Passeig Vall d鈥橦ebron 119-129, 08035, Barcelona, Spain
  2. Department of Obstetrics and Gynecology, Texas Children鈥檚 Fetal Center, Baylor College of Medicine, Houston, TX, USA
  
• ISSN：1432-2218

文摘

Background This study aimed to assess the feasibility of single-access fetal endoscopy (SAFE) for the management of myelomeningocele (MMC) using intrauterine carbon dioxide as a distension medium in a sheep model. Methods This prospective experimental case-control study investigated 12 lamb fetuses that had a myelomeningocele-like defect surgically created on the 75th day of gestation. Four fetuses remained untreated (control group), and eight fetuses had MMC repair using two fetoscopic approaches with carbon dioxide used to distend the amniotic cavity. A collagen patch was placed over the defect and secured with surgical sealant. Four animals had a two-port fetoscopic procedure, and four animals had SAFE. Clinical and pathologic studies were performed after delivery. Results This study confirmed the validity of the animal MMC model. None of the control animals was able to stand or walk, and all had a significant defect in the lumbar area with continuous leakage of cerebrospinal fluid, ventriculomegaly, and a Chiari-II malformation. All the treated animals, independently of the number of ports used in the repair, were able to walk and had a closed defect with resolution of the Chiari malformation. Conclusions The SAFE patch and glue coverage of surgically created fetal MMC is feasible and effective in restoring gross neurologic function in the fetal lamb model.