Safety and efficacy of fetal surgery techniques to close a spina bifida defect in the fetal lamb model: A systematic review

Joyeux, Luc; Bie, Felix De; Danzer, Enrico; Mieghem, Tim Van; Flake, Alan W.; Deprest, Jan

doi:10.1002/pd.5222

Cited by 24 publications

(30 citation statements)

References 73 publications

(227 reference statements)

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“…This led to the concept of fetal intervention to arrest or reverse the natural history. Successful fetal coverage of SBA with improved functional outcome was first demonstrated in the SBA fetal lamb model 22. This was translated clinically with encouraging early results in several small case series 23–25.…”

Section: Introduction and Rationalementioning

confidence: 92%

“…Further technical development was put on hold in the USA by a historic national agreement of the leading fetal therapy centres in support of the MOMS. Based on the results of this trial yet without much experimental evidence,22 many centres recently opened and started fetoscopic programmes. Outcomes on more than 200 fetoscopic SBA repairs are currently reported (table 4).…”

Section: Fetoscopic Surgery For Sbamentioning

confidence: 99%

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Fetal surgery for spina bifida aperta

Joyeux

Danzer

Flake

et al. 2018

Arch Dis Child Fetal Neonatal Ed

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Spina bifida aperta (SBA) is one of the most common congenital malformations. It can cause severe lifelong physical and neurodevelopmental disabilities. Experimental and clinical studies have shown that the neurological deficits associated with SBA are not simply caused by incomplete neurulation at the level of the lesion. Additional damage is caused by prolonged exposure of the spinal cord and nerves to the intrauterine environment and a suction gradient due to cerebrospinal fluid leakage, leading to progressive downward displacement of the hindbrain. This natural history can be reversed by prenatal repair. A randomised controlled trial demonstrated that mid-gestational maternal-fetal surgery for SBA decreases the need for ventriculoperitoneal shunting and hindbrain herniation at 12 months and improves neurological motor function at 30 months of age. This came at the price of maternal and fetal risks, the most relevant ones being increased prematurity and a persistent uterine corporeal scar. Recently minimally invasive fetal approaches have been introduced clinically yet they lack extensive experimental or clinical trials. We aim to provide clinicians with the essential information necessary to counsel SBA parents as the basis for considering referral of selected patients to expert fetal surgery centres. We review the reported clinical outcomes and discuss recent developments of potentially less invasive fetal SBA approaches.

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Section: Introduction and Rationalementioning

confidence: 92%

Section: Fetoscopic Surgery For Sbamentioning

confidence: 99%

Fetal surgery for spina bifida aperta

Joyeux

Danzer

Flake

et al. 2018

Arch Dis Child Fetal Neonatal Ed

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“…Animal models of spina bifida have suggested that open fetal repair is safe and effective . The first open fetal spina bifida repair in humans was performed in 1998 and, over the following 5 years, several observational studies were published with generally encouraging results.…”

Section: Open Fetal Repair Of Spina Bifidamentioning

confidence: 99%

Fetal surgery for open spina bifida

Sacco

Ushakov

Thompson

et al. 2019

The Obstetric & Gynaecologis

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Key content Spina bifida is a congenital neurological condition with lifelong physical and mental effects. Open fetal repair of the spinal lesion has been shown to improve hindbrain herniation, ventriculoperitoneal shunting, independent mobility and bladder outcomes for the child and, despite an increased risk of prematurity, does not seem to increase the risk of neurodevelopmental impairment. Open fetal surgery is associated with maternal morbidity. Surgery at our institution is offered and performed according to internationally agreed criteria and protocols. Further evidence regarding long‐term outcomes, fetoscopic repair and alternative techniques is awaited. Learning objectives To understand the clinical effects, potential prevention and prenatal diagnosis of spina bifida. To understand the rationale and evidence supporting the benefits and risks of fetal repair of open spina bifida. To understand the criteria defining those who are likely to benefit from fetal surgery. Ethical issues The concept of the fetus as a patient, and issues surrounding fetal death or the need for resuscitation during fetal surgery. The associated maternal morbidity in a procedure performed solely for the benefit of the fetus/child. The financial implications of new surgical treatments.

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“…The debate concerning the optimal surgical approach for fetoscopic MMC repair is ongoing, as discussed in several recent papers on this subject, and is thus not the focus of this review . However, optimization of the PACI technique may also influence clinical outcomes and is potentially relevant to other surgeries, such as fetoscopic laser coagulation …”

Section: Fetal Surgery For Myelomeningocelementioning

confidence: 99%

“…9 The debate concerning the optimal surgical approach for fetoscopic MMC repair is ongoing, as discussed in several recent papers on this subject, and is thus not the focus of this review. 25,[27][28][29] However, optimization of the PACI technique may also influence clinical outcomes and is potentially relevant to other surgeries, such as fetoscopic laser coagulation. 30 3 | CARBON DIOXIDE PHYSIOLOGY CO 2 is a highly soluble by product of aerobic cellular metabolism that rapidly diffuses from tissues into the blood (Figure 1).…”

Section: Fetal Surgery For Myelomeningocelementioning

confidence: 99%

Partial amniotic carbon dioxide insufflation for fetal surgery

et al. 2018

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Partial amniotic carbon dioxide insufflation (PACI) involves insufflating the amniotic sac with carbon dioxide (CO2) and, in some cases, draining some of the amniotic fluid. The creation of a gaseous intra‐amniotic compartment improves visualization, even in the presence of limited bleeding, and creates the work space required for complex fetoscopic procedures. Clinically, PACI is mostly used to perform fetoscopic myelomeningocele (MMC) repair, enabling a minimally invasive alternative to open fetal surgery. However, evidence of the fetal safety of PACI is limited. Previous animal experiments in sheep demonstrate that PACI induces fetal hypercapnia and acidosis with largely unknown short and longer term implications. In this review, we examine the literature for the physiological effects of intrauterine insufflation pressure, duration, humidity, and the role of maternal hyperventilation on fetal physiology and well‐being.

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Safety and efficacy of fetal surgery techniques to close a spina bifida defect in the fetal lamb model: A systematic review

Cited by 24 publications

References 73 publications

Fetal surgery for spina bifida aperta

Fetal surgery for spina bifida aperta

Fetal surgery for open spina bifida

Partial amniotic carbon dioxide insufflation for fetal surgery

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