Fetoscopic coverage of experimental myelomeningocele in sheep using a patch with surgical sealant

Fontecha, César G.; Peiró, José L.; Sevilla, Juan J.; Useche, María Cristina; Soldado, Francisco; Fresno, Laura; Fonseca, Carla; Chacaltana, Asiul; Martínez, Vicente

doi:10.1016/j.ejogrb.2010.12.046

Cited by 44 publications

(25 citation statements)

References 32 publications

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“…Maternal morbidity associated with open correction suggests that minimally invasive methods are the future of antenatal correction of myelomeningocele. Some authors have studied the endoscopic correction of this defect both in animal models (14)(15)(16) and in humans (17) -in…”

Section: Discussionmentioning

confidence: 99%

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Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep

Herrera

Leme

Valente

et al. 2012

Einstein (São Paulo)

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Objective: To compare the classical neurosurgical technique with a new simplified technique for prenatal repair of a myelomeningocelelike defect in sheep. Methods: A myelomeningocele-like defect (laminectomy and dural excision) was created in the lumbar region on day 90 of gestation in 9 pregnant sheep. Correction technique was randomized. In Group 1 the defect was corrected using the classic neurosurgical technique of three-layer suture (dura mater, muscle and skin closure) performed by a neurosurgeon. In Group 2, a fetal medicine specialist used a biosynthetic cellulose patch to protect the spinal cord and only the skin was sutured above it. Near term (day 132 of gestation) fetuses were sacrificed for pathological analysis. Results: There were two miscarriages and one maternal death. In total, six cases were available for pathological analysis, three in each group. In Group 1, there were adherence of the spinal cord to the scar (meningo-neural adhesion) and spinal cord architecture loss with posterior funiculus destruction and no visualization of grey matter. In Group 2, we observed in all cases formation of a neo-dura mater, separating the nervous tissue from adjacent muscles, and preserving the posterior funiculus and grey matter. Conclusion: The new simplified technique was better than the classic neurosurgical technique. It preserved the nervous tissue and prevented the adherence of the spinal cord to the scar. This suggests the current technique used for the correction of spina bifida in humans may need to be reassessed. de ovelhas. Métodos: Em 9 fetos, foi criado um defeito semelhante à mielomeningocele (laminectomia e excisão de dura-máter) no 90° dia de gestação. O tipo de correção foi randomizado. No Grupo 1, o defeito foi corrigido usando a técnica neurocirúrgica clássica, com a sutura de três camadas (dura-máter, músculo e pele), realizada por um neurocirurgião. No Grupo 2, um especialista em Medicina Fetal utilizou a técnica simplificada, colocando um fragmento de celulose biossintética sobre a medula e suturando apenas da pele sobre a celulose. Próximo ao termo da gestação (132 dias), os fetos foram sacrificados para análise anatomopatológica. Resultados: Ocorreram dois casos de aborto e uma morte materna, restando seis casos para avaliação -três em cada grupo. No Grupo 1, todos os casos mostraram aderência da medula à cicatriz (meningoadesão) e perda da arquitetura medular, com destruição do funículo posterior e perda da visualização da substância cinzenta. No Grupo 2, observou-se, em todos os casos, a formação de uma neodura-máter, separando o tecido nervoso do músculo adjacente, sendo que o funículo posterior e a substância cinzenta estavam preservados. Conclusão: A técnica simplificada foi superior à neurocirúrgica, com maior preservação da medula e evitando as aderências do tecido nervoso. Os presentes achados sugerem que a técnica utilizada atualmente na correção de mielomeningocele em fetos humanos deva ser reavaliada. Keywords

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Section: Discussionmentioning

confidence: 99%

“…Also, the use of glues, sealants, and different sutures have been reported (14,18,19) . Biosynthetic cellulose was tested as dura mater substitute in dogs submitted to craniotomy by Mello et al (18) , and it was found that it induced the formation of neo-dura mater.…”

Section: A D B E C Fmentioning

confidence: 99%

Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep

Herrera

Leme

Valente

et al. 2012

Einstein (São Paulo)

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“…Several papers have been published focusing on the development of a minimally invasive approach in fetal surgical repair for MMC in order to decrease the risk of neural injury by early gestation MMC closure as well as to decrease the associated maternal and fetal risks [37,38,45]. All studies to date have applied scaffolds via fetoscopy with or without maternal laparotomy, and most have performed their interventions in the surgically created sheep model.…”

Section: Experimental Progress In the Development Of A Minimally Invamentioning

confidence: 99%

“…To date, experimental studies of tissue engineering approaches to prenatal repair of MMC can be divided into 2 groups according to the goals of the investigators: (1) to prevent amniotic fluid-induced neural damage by providing coverage of the defect using scaffolds [31,32,33,34,35,36,37,38] and (2) to place a scaffold and/or cells between the neural tissue and the skin repair to prevent adhesion of the repair to the cord (tethering) and/or to provide neurotrophic factors or regenerate neural tissue [39,40,41,42,43,44]. …”

Section: Experimental Progress In Tissue Engineering For Fetal MMCmentioning

confidence: 99%

Tissue Engineering Strategies for Fetal Myelomeningocele Repair in Animal Models

2014

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Myelomeningocele (MMC), the most severe form of spina bifida, is a common and devastating malformation. Over two decades of experimental work in animal models have led to the development and clinical application of open fetal surgery for the repair of the MMC defect. This approach offers improved neurofunctional outcomes and is now a clinical option for the management of prenatally diagnosed MMC in selected patients. However, there are still opportunities for further improvement in the prenatal treatment of MMC. A less invasive approach would allow for an application earlier in gestation, with a reduction in maternal and fetal risks and the potential for reduced neurological injury. Tissue engineering offers a realistic and appealing alternative approach for the prenatal treatment of MMC. This review discusses the rationale for tissue engineering in MMC, addresses recent experimental progress and describes potential future directions.

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“…The development of tissue glues and bioengineering strategies may allow less invasive closure techniques [18,19,20,21]. While these hold promise, they are still experimental, and it will be important to show they are feasible in small and large animal models and carefully designed human studies before they are widely employed.…”

Section: Special Considerationsmentioning

confidence: 99%

Fetal Myelomeningocele Closure: Technical Considerations

Heuer¹,

Adzick²,

Sutton³

2014

Fetal Diagn Ther

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Myelomeningocele (MMC) is one of the most common serious congenital malformations. Typically this condition has been treated with closure of the MMC defect shortly after birth. In general, surgery for MMC aims to provide a multilayered closure to provide protection to the neural elements, prevent leakage of spinal fluid and reduce infection risks. A randomized controlled trial, the Management of Myelomeningocele Study (MOMS), has shown that closure during the fetal period can be performed relatively safely and can result in significant benefit to the child. Whereas the surgical technique of prenatal closure of an MMC defect is similar to a postnatal closure, there are some important technical differences. The goal of this paper is to describe the technique of fetal closure of MMC defects, highlight the unique steps that are needed for this surgery and delineate some potential pitfalls.

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Fetoscopic coverage of experimental myelomeningocele in sheep using a patch with surgical sealant

Cited by 44 publications

References 32 publications

Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep

Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep

Tissue Engineering Strategies for Fetal Myelomeningocele Repair in Animal Models

Fetal Myelomeningocele Closure: Technical Considerations

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