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 language | English |
|---|---|
| Pages (from-to) | E12 |
| Journal | Neurosurgical Focus |
| Volume | 47 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Oct 1 2019 |
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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
Minimally invasive fetal surgery for myelomeningocele : preliminary report from a single center. / Carrabba, Giorgio; Macchini, Francesco; Fabietti, Isabella; Schisano, Luigi; Meccariello, Giulia; Campanella, Rolando; Bertani, Giulio; Locatelli, Marco; Boito, Simona; Porro, Giuliana A.; Gabetta, Lorenzo; Picciolini, Odoardo; Cinnante, Claudia; Triulzi, Fabio; Ciralli, Fabrizio; Mosca, Fabio; Lapa, Denise A.; Leva, Ernesto; Rampini, Paolo; Persico, Nicola.
In: Neurosurgical Focus, Vol. 47, No. 4, 01.10.2019, p. E12.Research output: Contribution to journal › Article
}
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.
KW - fetoscopy
KW - hydrocephalus
KW - MMC = myelomeningocele
KW - MOMS = Management of Myelomeningocele Study
KW - myelomeningocele
KW - PROM = premature rupture of membranes
KW - spina bifida
UR - http://www.scopus.com/inward/record.url?scp=85072847958&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85072847958&partnerID=8YFLogxK
U2 - 10.3171/2019.8.FOCUS19438
DO - 10.3171/2019.8.FOCUS19438
M3 - Article
C2 - 31574466
AN - SCOPUS:85072847958
VL - 47
SP - E12
JO - Neurosurgical Focus
JF - Neurosurgical Focus
SN - 1092-0684
IS - 4
ER -