Minimally invasive fetal surgery for myelomeningocele: preliminary report from a single center

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Recent 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. METHODS: Preoperative 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. RESULTS: Five 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. CONCLUSIONS: The 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.

Original languageEnglish
Pages (from-to)E12
JournalNeurosurgical Focus
Volume47
Issue number4
DOIs
Publication statusPublished - Oct 1 2019

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Meningomyelocele
Minimally Invasive Surgical Procedures
Rhombencephalon
Hydrocephalus
Gestational Age
Fetus
Mothers
Newborn Infant
Therapeutics
Informed Consent
Pregnant Women
Ultrasonography
Sepsis
Safety
Infection

Keywords

  • fetoscopy
  • hydrocephalus
  • MMC = myelomeningocele
  • MOMS = Management of Myelomeningocele Study
  • myelomeningocele
  • PROM = premature rupture of membranes
  • spina bifida

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

@article{ce16b6b491ff44f6b699ea2773f0cef0,
title = "Minimally invasive fetal surgery for myelomeningocele: preliminary report from a single center",
abstract = "OBJECTIVE: Recent 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. METHODS: Preoperative 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. RESULTS: Five 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. CONCLUSIONS: The 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.",
keywords = "fetoscopy, hydrocephalus, MMC = myelomeningocele, MOMS = Management of Myelomeningocele Study, myelomeningocele, PROM = premature rupture of membranes, spina bifida",
author = "Giorgio Carrabba and Francesco Macchini and Isabella Fabietti and Luigi Schisano and Giulia Meccariello and Rolando Campanella and Giulio Bertani and Marco Locatelli and Simona Boito and Porro, {Giuliana A.} and Lorenzo Gabetta and Odoardo Picciolini and Claudia Cinnante and Fabio Triulzi and Fabrizio Ciralli and Fabio Mosca and Lapa, {Denise A.} and Ernesto Leva and Paolo Rampini and Nicola Persico",
year = "2019",
month = "10",
day = "1",
doi = "10.3171/2019.8.FOCUS19438",
language = "English",
volume = "47",
pages = "E12",
journal = "Neurosurgical Focus",
issn = "1092-0684",
publisher = "American Association of Neurological Surgeons",
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TY - JOUR

T1 - Minimally invasive fetal surgery for myelomeningocele

T2 - preliminary report from a single center

AU - Carrabba, Giorgio

AU - Macchini, Francesco

AU - Fabietti, Isabella

AU - Schisano, Luigi

AU - Meccariello, Giulia

AU - Campanella, Rolando

AU - Bertani, Giulio

AU - Locatelli, Marco

AU - Boito, Simona

AU - Porro, Giuliana A.

AU - Gabetta, Lorenzo

AU - Picciolini, Odoardo

AU - Cinnante, Claudia

AU - Triulzi, Fabio

AU - Ciralli, Fabrizio

AU - Mosca, Fabio

AU - Lapa, Denise A.

AU - Leva, Ernesto

AU - Rampini, Paolo

AU - Persico, Nicola

PY - 2019/10/1

Y1 - 2019/10/1

N2 - OBJECTIVE: Recent 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. METHODS: Preoperative 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. RESULTS: Five 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. CONCLUSIONS: The 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.

AB - OBJECTIVE: Recent 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. METHODS: Preoperative 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. RESULTS: Five 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. CONCLUSIONS: The 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.

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KW - hydrocephalus

KW - MMC = myelomeningocele

KW - MOMS = Management of Myelomeningocele Study

KW - myelomeningocele

KW - PROM = premature rupture of membranes

KW - spina bifida

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