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Fetoscopic coverage of experimental myelomeningocele in sheep using a patch with surgical sealant
Cesar G Fontecha1, Jose L Peiro, Juan J Sevilla
1Paediatric Orthopaedic Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain. cgarcia@ir.vhebron.net
Objective:
Assess the feasibility of a fetoscopic patch coverage method for myelomeningocele repair in a sheep model.
Study Design:
Experimental study. A myelomeningocele-like defect was created in 15 fetal sheep on day 75 of gestation. Six remained untreated, whereas 9 underwent fetoscopic coverage of the defect on day 95 of gestation using an inert patch secured with surgical sealant. Clinical and histological examinations were performed after delivery.
Results:
Four valid newborn lambs were obtained in each group. Mean fetoscopic surgical time was 26.9 (SD=7.4)min. All untreated animals had an open lumbar defect with cerebrospinal fluid leakage, paraplegia, urinary incontinence, and Chiari malformation. All treated animals had a closed defect and were able to walk; one had weak bladder control, and another mild Chiari malformation.
Conclusion:
In a chronic myelomeningocele model in fetal sheep, fetoscopic repair using a sealed patch results in simple, fast, satisfactory neural tube closure and averts neurological damage and Chiari malformation.
