Fetoscopic single-layer repair of open spina bifida using a cellulose patch: preliminary clinical experience
Denise A L Pedreira1, Nelci Zanon, Renato A M de Sá
1Pathology Department, University of São Paulo , São Paulo , Brazil .
Insights
Fetoscopic antenatal correction of open spina bifida (OSB) is feasible with a simplified technique. This approach showed promising results, including improved hindbrain herniation and reduced need for neonatal surgery.
Area of Science:
- Fetal surgery
- Minimally invasive techniques
- Neural tube defects
Background:
- Open spina bifida (OSB) is a severe congenital condition requiring significant neonatal intervention.
- Antenatal surgical repair aims to improve outcomes for fetuses diagnosed with OSB.
- Fetoscopic techniques offer a minimally invasive alternative to open fetal surgery.
Observation:
- Four fetuses with lumbar-sacral OSB underwent in utero repair between 25-27 weeks gestation.
- A percutaneous fetoscopic approach with three trocars and CO2 insufflation was employed.
- A simplified closure involved a cellulose patch and a continuous stitch.
Findings:
- Successful surgical closure was achieved in 3 of 4 cases.
- Improved hindbrain herniation was observed in all successful repairs.
- Two neonates did not require further neurosurgical intervention; two did not require shunting.
Implications:
- This preliminary study suggests the feasibility of fetoscopic repair for OSB.
- The innovative technique may reduce the need for neonatal surgery and shunting.
- A Phase I trial is underway to further evaluate this fetoscopic correction method.
Objective:
To report our preliminary clinical experience in the antenatal correction of open spina bifida (OSB) using a fetoscopic approach and a simplified closure technique.
Methods:
Four fetuses with lumbar-sacral defects were operated in utero from 25 to 27 weeks. Surgeries were performed percutaneously under general anesthesia using three trocars and partial carbon dioxide insufflation. After dissection of the neural placode, the surrounding skin was closed over a cellulose patch using a single continuous stitch.
Results:
Surgical closure was successful in three of the four cases. All successful cases showed improvement of the hindbrain herniation and no neonatal neurosurgical repair was required in two cases. Delivery occurred between 31 and 33 weeks, and no fetal or neonatal deaths occurred. Ventriculoperitoneal shunting was not needed in two out of the 3 successful cases.
Conclusions:
Our preliminary experience suggests that definitive fetoscopic repair of OSB is feasible using our innovative surgical technique. A phase I trial for the fetoscopic correction of OSB with this technique is currently being conducted.
