P09.24: Intrauterine treatment of a suprasellar inter‐hemispheric arachnoid cyst by feto‐cisternoscopy

Abstract

22nd World Congress on Ultrasound in Obstetrics and GynecologyPoster abstracts acardiac twin was performed. Under fetoscopic observation, the cord was resected by scissors which inserted through operating channel in fetoscope. The patient delivered a 2290 g, female infant at 32 weeks of gestation after spontaneous rupture of membrane. Gross specimen of the placenta and acardiac twin showed complete obstruction of the anastomoses and no cord entanglement. P09.22Perinatal outcomes following radiofrequency ablation in monochorionic pregnancies Results: 84 cases of RFA were performed (31 for structural anomaly, 9 for TRAP, 20 for TTTS, 2 for aneuploidy, 11 for MFPR, 11 for FGR). The median gestation at RFA was 17.5 weeks (range 12.1-27.6 weeks). The overall live birth rate was 82%. PPROM and/or miscarriage within 2 weeks occurred in 3% of cases respectively. Co-twin IUD occurred in 13% of cases. The median gestation at delivery was 35 weeks (Range 14-41 weeks). The preterm (< 37 weeks) live birth rate was 45%. The incidence of brain injury following the RFA was 4.5%. Neonatal death occurred in 1.2% of cases. The incidence of co-twin demise appeared greatest (19.2%) when the RFA was performed before 16 weeks compared to after 16 weeks (13.9%), although this did not reach significance (P = 0.082). There were no maternal complications. Conclusions: RFA is a safe technique for selective reduction in MC pregnancies and can be performed much earlier compared with other methods. The risk of co-twin demise appears greatest before 16 weeks gestation. P09.23A clinical trial of ultrasound treatment for TRAP sequence We present a case of TRAP sequence for which high-intensity focused ultrasound (HIFU) was applied as a non-invasive fetal therapy. Case; A 23-year-old woman was admitted to our hospital at 22 gestational weeks. Ultrasonography led to a diagnosis of TRAP sequence. Neither hydramnios nor signs of heart failure were identified in the normal fetus, but because the anomalous fetus displayed pronounced subcutaneous edema, the decision was made at 26 gestational week to apply ultrasound-guided HIFU exposure to occlude the vessel and interrupt the blood flow of the anomalous fetus. The Ethics Committee for Clinical Studies approved the procedure and consent was obtained from the patient after explanation. Target for HIFU exposure was the internal blood flow at the point where the umbilical cord entered the body of the anomalous fetus. Exposure was performed multiple times and decreased blood flow was confirmed by Doppler color imaging; however, complete occlusion was not achieved. Despite the failure of complete occlusion, a hyperechoic area was observed just proximal to the target blood; this finding indicated degeneration of the tissue by exposure to HIFU. Collateral damage was not seen in either the pump fetus or the mother's body. Polyhydramnios appeared at 29 gestational weeks, thus making premature birth an imminent threat. Therefore, a cesarean section was performed. The pump fetus weighed 845 g, the anomalous fetus...

Fetal arachnoid cyst: characteristics, management in pregnancy, and neurodevelopmental outcomes

“…Arachnoid cysts on the skull base showed more progression than those in other locations [19], with a 50% increase in the volume of suprasellar cysts during pregnancy [33]. Some reports have investigated experimental treatment using fetoscopy when the cyst size increases rapidly [33,44]. Chalouhi et al [44] reported that fetocisternoscopy with fenestration of the cystic wall cyst was successfully performed at 31 weeks in a fetus with a rapidly growing cyst.…”

“…Some reports have investigated experimental treatment using fetoscopy when the cyst size increases rapidly [ 33 , 44 ]. Chalouhi et al [ 44 ] reported that fetocisternoscopy with fenestration of the cystic wall cyst was successfully performed at 31 weeks in a fetus with a rapidly growing cyst. The baby was born at 36 weeks of gestation, underwent an additional cisternoscopy after birth, and maintained good health after surgery.…”