scholarly journals Open Fetal Microneurosurgery for Intrauterine Spina Bifida Repair

2021 ◽  
pp. 1-11
Author(s):  
Rogelio Cruz-Martínez ◽  
Felipe Chavelas-Ochoa ◽  
Miguel Martínez-Rodríguez ◽  
Karla Aguilar-Vidales ◽  
Alma Gámez-Varela ◽  
...  
Keyword(s):  
Spina Bifida ◽  
Amniotic Fluid ◽  
Open Surgery ◽  
Perinatal Death ◽  
Fetal Surgery ◽  
Perinatal Outcomes ◽  
Surgery Technique ◽  
Ventriculoperitoneal Shunting ◽  
Surgery Center

<b><i>Objectives:</i></b> The aim of the study was to describe the feasibility of open fetal microneurosurgery for intrauterine spina bifida (SB) repair and to compare perinatal outcomes with cases managed using the classic open fetal surgery technique. <b><i>Methods:</i></b> In this study, we selected a cohort of consecutive fetuses with isolated open SB referred to our fetal surgery center in Queretaro, Mexico, during a 3.5-year period (2016–2020). SB repair was performed by either classic open surgery (6- to 8-cm hysterotomy with leakage of amniotic fluid, which was replaced before uterine closure) or open microneurosurgery, which is a novel technique characterized by a 15- to 20-mm hysterotomy diameter, reduced fetal manipulation by fixing the fetal back, and maintenance of normal amniotic fluid and uterine volume during the whole surgery. Perinatal outcomes of cases operated with the classic open fetal surgery technique and open microneurosurgery were compared. <b><i>Results:</i></b> Intrauterine SB repair with a complete 3-layer correction was successfully performed in 60 cases either by classic open fetal surgery (<i>n</i> = 13) or open microneurosurgery (<i>n</i> = 47). No significant differences were observed in gestational age (GA) at fetal intervention (25.4 vs. 25.1 weeks, <i>p</i> = 0.38) or surgical times (107 vs. 120 min, <i>p</i> = 0.15) between both groups. The group with open microneurosurgery showed a significantly lower rate of oligohydramnios (0 vs. 15.4%, <i>p</i> = 0.01), preterm rupture of the membranes (19.0 vs. 53.8%, <i>p</i> = 0.01), higher GA at birth (35.1 vs. 32.7 weeks, <i>p</i> = 0.03), lower rate of preterm delivery &#x3c;34 weeks (21.4 vs. 61.5%, <i>p</i> = 0.01), and lower rate of perinatal death (4.8 vs. 23.1%, <i>p</i> = 0.04) than the group with classic open surgery. During infant follow-up, the rate of hydrocephalus requiring ventriculoperitoneal shunting was similar between both groups (7.5 vs. 20%, <i>p</i> = 0.24). All patients showed an intact hysterotomy site at delivery. <b><i>Conclusion:</i></b> Intrauterine spina repair by open fetal microneurosurgery is feasible and was associated with better perinatal outcomes than classic open fetal surgery.

Single Uterine Access for Bilateral Pleuroamniotic Shunting in Fetuses with Severe Hydrothorax by an Internal Rotational Maneuver: Feasibility and Outcomes between Successful and Failed Procedures

2021 ◽  
Vol 48 (3) ◽  
pp. 209-216
Author(s):  
Rogelio Cruz-Martínez ◽  
Cristian Sosa Sosa ◽  
Miguel Martínez-Rodríguez ◽  
Alma Gámez-Varela ◽  
Rosa Villalobos-Gómez ◽  
...  
Keyword(s):  
Survival Rate ◽  
Prospective Cohort ◽  
Lower Risk ◽  
Perinatal Death ◽  
Fetal Surgery ◽  
Perinatal Outcomes ◽  
Fetal Intervention ◽  
Surgical Time ◽  
Final Population ◽  
Surgery Center

<b><i>Objective:</i></b> The objective of this study was to describe the feasibility of single percutaneous uterine access for bilateral pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax by using an internal rotational maneuver and to compare perinatal outcomes between successful and failed procedures. <b><i>Methods:</i></b> A prospective cohort of 25 fetuses with isolated bilateral hydrothorax and hydrops were referred to our fetal surgery center in Queretaro, Mexico during an 8-year period. Bilateral PAS was first attempted through a percutaneous single uterine access by internal rotation of the fetus, which was achieved by using the blunt tip of the same cannula, and in case of a failed procedure, a second uterine port was used to place the second shunt. The perinatal outcomes between successful (single uterine port) and failed (2 uterine ports) fetal procedures were compared. <b><i>Results:</i></b> Placing of bilateral shunts through a percutaneous single uterine access was feasible in 15/25 (60%) cases. Overall, median GA at delivery was 35.2 weeks with a survival rate of 64.0% (16/25). Three cases were excluded due to shunt dislodgement, leaving a final population of 22 fetuses; 13/22 (59.1%) and 9/22 (40.9%) managed using 1 and 2 uterine ports, respectively. The group with bilateral PAS placement through a successful single uterine port showed a significantly higher GA at birth (36.5 vs. 32.8 weeks, <i>p</i> = 0.001), lower surgical time (11.0 vs. 19.0 min, <i>p</i> = 0.01), longer interval between fetal intervention and delivery (5.7 vs. 2.7 weeks, <i>p</i> = 0.01), lower risk of preterm delivery (46.2 vs. 100%, <i>p</i> &#x3c; 0.01), and lower rate of perinatal death (15.4 vs. 55.6%, <i>p</i> &#x3c; 0.05) than the failed procedures requiring 2 uterine ports. <b><i>Conclusion:</i></b> In fetuses with severe bilateral hydrothorax and hydrops, bilateral pleuroamniotic shunting through a successful single percutaneous uterine access is feasible in up to 60% of cases and is associated with better perinatal outcomes.

scholarly journals Fetal surgery for spina bifida aperta

2018 ◽  
Vol 103 (6) ◽  
pp. F589-F595 ◽  
Author(s):  
Luc Joyeux ◽  
Enrico Danzer ◽  
Alan W Flake ◽  
Jan Deprest
Keyword(s):  
Spina Bifida ◽  
Prolonged Exposure ◽  
Controlled Trial ◽  
Fetal Surgery ◽  
Neurological Deficits ◽  
Cerebrospinal Fluid Leakage ◽  
Essential Information ◽  
Ventriculoperitoneal Shunting ◽  
Spina Bifida Aperta ◽  
Randomised Controlled

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.

scholarly journals Maternal and Perinatal Outcomes in Childbirths with Meconium Stained Amniotic Fluid in a Low-resource Setting: A Prospective Cohort Study

2019 ◽  
pp. 1-11
Author(s):  
Gregory E. Halle-Ekane ◽  
Phyllis N. Fon ◽  
Paul N. Koki ◽  
Alexis A. Tazinya ◽  
Rodrigue Ekollo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Amniotic Fluid ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Neonatal Intensive Care ◽  
Perinatal Death ◽  
Perinatal Outcomes ◽  
Neonatal Morbidity ◽  
Resource Setting ◽  
Meconium Stained Amniotic Fluid

Meconium stained amniotic fluid (MSAF) can be associated with a high maternal and perinatal mortality. There is paucity of data on maternal and fetal outcomes of MSAF in Cameroon. Aim: The study was to determine the maternal and perinatal outcomes in patients with MSAF. Study Design: Prospective cohort study. Place and Duration of Study: The study carried out in the Limbe Regional Hospital maternity, Cameroon from 10th January 2017 to 20th April 2017. Methodology:  Fifty- two mothers who had MSAF and their neonates, were matched with controls (without MSAF) in a 1:1 ratio after matching for: age, gestational age, parity and body mass index. Risk ratio (RR) of MSAF on the various perinatal outcomes were calculated by multivariate logistic regression with MSAF (-) being the reference. Data was analyzed with Epi Info 7. Results: Two hundred and three deliveries were conducted during the study period with fifty-two with MSAF enrolled in the study. The proportion of participants with MSAF was 19.1%. Parturients who had thick MSAF were 3 times more likely to have caesarean sections (RR: 3.2, 95% CI= 1.1 - 10.2, p = 0.04). Two (3.9%) parturients with chorioamnionitis had MSAF. The neonatal complications were: non- reassuring fetal heart rate (RR=4.4, 95%CI: 1.1-16.8, p=0.02), neonatal sepsis (RR=3.7, 95%CI: 1.4-9.8, p=0.01) and neonatal intensive care unit admissions (RR=2.9, 95%CI: 1.2-6.9, p=0.02), were associated with MSAF. Two (3.9%) had meconium aspiration syndrome on clinical examination. No maternal death was recorded. However, a perinatal death occurred in a parturient with MSAF. Conclusion: The proportion of parturients with MSAF was high. MSAF was associated with increased maternal and neonatal morbidity.  We recommend larger and robust cohort studies to further refine our findings.

Implementation Process and Evolution of a Laparotomy-Assisted 2-Port Fetoscopic Spina Bifida Closure Program

2021 ◽  
pp. 1-8
Author(s):  
Jena L. Miller ◽  
Mari L. Groves ◽  
Edward S. Ahn ◽  
David J. Berman ◽  
Jamie D. Murphy ◽  
...  
Keyword(s):  
Spina Bifida ◽  
Program Implementation ◽  
Fetal Surgery ◽  
Perinatal Outcomes ◽  
Implementation Process ◽  
Cerebrospinal Fluid Leak ◽  
Neurologic Outcomes ◽  
Ancillary Staff ◽  
Gestational Age At Birth ◽  
Fluid Leak

<b><i>Introduction:</i></b> Prenatal closure of open spina bifida via open fetal surgery improves neurologic outcomes for infants in selected pregnancies. Fetoscopic techniques that are minimally invasive to the uterus aim to provide equivalent fetal benefits while minimizing maternal morbidities, but the optimal technique is undetermined. We describe the development, evolution, and feasibility of the laparotomy-assisted 2-port fetoscopic technique for prenatal closure of fetal spina bifida in a newly established program. <b><i>Methods:</i></b> We conducted a retrospective cohort study of women consented for laparotomy-assisted fetoscopic closure of isolated fetal spina bifida. Inclusion and exclusion criteria followed the Management of Myelomeningocele Study (MOMS). Team preparation involved observation at the originating center, protocol development, ancillary staff training, and surgical rehearsal using patient-matched models through simulation prior to program implementation. The primary outcome was the ability to complete the repair fetoscopically. Secondary maternal and fetal outcomes to assess performance of the technique were collected prospectively. <b><i>Results:</i></b> Of 57 women screened, 19 (33%) consented for laparotomy-assisted 2-port fetoscopy between February 2017 and December 2019. Fetoscopic closure was completed in 84% (16/19) cases. Over time, the technique was modified from a single- to a multilayer closure. In utero hindbrain herniation improved in 86% (12/14) of undelivered patients at 6 weeks postoperatively. Spontaneous rupture of membranes occurred in 31% (5/16) of fetoscopic cases. For completed cases, median gestational age at birth was 37 (range 27–39.6) weeks and 50% (8/16) of women delivered at term. Vaginal birth was achieved in 56% (9/16) of patients. One newborn had a cerebrospinal fluid leak that required postnatal surgical repair. <b><i>Conclusion:</i></b> Implementation of a laparotomy-assisted 2-port fetoscopic spina bifida closure program through rigorous preparation and multispecialty team training may accelerate the learning curve and demonstrates favorable obstetric and perinatal outcomes.

OPEN HAEMORRHOIDS SURGERY IN SPINAL CORD INJURY PATIENTS

2020 ◽  
Vol 4 (11) ◽  
Author(s):  
Khaled Hassan
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Anal Fissure ◽  
Open Surgery ◽  
Anal Fissures ◽  
Cord Injury ◽  
Long Term Follow Up ◽  
Grade Iii

This Pilot retrospective research conducted on the results of open surgery in patients with Grade III and IV haemorrhoids With SCI. No major complications had arisen at 6 weeks post-operative and all wounds had healed, but 1 patient Anal fissure recurrence. 75% of patients reported a substantial increase in anorectal anorexia during long-term follow-up. With symptoms. Five patients reported recurrences: three haemorrhoids (18 percent) and two anal fissures (25 percent).   Keywords: Haemorrhoids, Pilot retrospective research, Anorectal Anorexia.

scholarly journals ‘We did everything we could’– A qualitative study exploring the acceptability of maternal‐fetal surgery for spina bifida to parents

2021 ◽  
Author(s):  
Neeltje Crombag ◽  
Adalina Sacco ◽  
Bernadette Stocks ◽  
Philippe De Vloo ◽  
Johannes Van Der Merwe ◽  
...  
Keyword(s):  
Spina Bifida ◽  
Qualitative Study ◽  
Fetal Surgery

Grief Reactions to Perinatal Death — a Follow-Up Study

1984 ◽  
Vol 29 (1) ◽  
pp. 14-19 ◽  
Author(s):  
C. Laroche ◽  
M. Lalinec-Michaud ◽  
F. Engelsmann ◽  
N. Fuller ◽  
M. Copp ◽  
...  
Keyword(s):  
Perinatal Death ◽  
Follow Up Study ◽  
Grief Reactions

Cervical Perimedullary Arteriovenous Shunts

Neurosurgery ◽  
2014 ◽  
Vol 75 (3) ◽  
pp. 238-249 ◽  
Author(s):  
Toshiki Endo ◽  
Hiroaki Shimizu ◽  
Kenichi Sato ◽  
Kuniyasu Niizuma ◽  
Ryushi Kondo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Anterior Approach ◽  
Open Surgery ◽  
Treatment Strategies ◽  
Good Recovery ◽  
Intraoperative Angiography ◽  
Indocyanine Green Videoangiography ◽  
Arteriovenous Shunts ◽  
Complete Obliteration

Abstract BACKGROUND: Reports of cervical perimedullary arteriovenous shunt (PMAVS) are limited, and treatment strategies have not been established. OBJECTIVE: To describe angioarchitecture and optimal treatment strategies for cervical PMAVS. METHODS: We treated 22 patients with cervical PMAVS between 2000 and 2012 (8 women and 14 men; age, 9-80 years). According to the classification, our patients included type IVa (4 patients), type IVb (16 patients), and type IVc (2 patients). Seventeen patients presented with subarachnoid hemorrhage. RESULTS: A total of 41 shunting points were localized in 22 patients, of which 34 points were located ventral or ventrolateral to the spinal cord. The anterior spinal artery (ASA) contributed to the shunts in 16 patients. Aneurysm formation was identified in 8 patients. Endovascular treatment was attempted in 3 patients, resulting in complete obliteration in 1 patient (type IVc). Overall, 21 patients underwent open surgery. An anterior approach with corpectomy was elected for 2 patients; the other 19 patients underwent the posterior approaches using indocyanine green videoangiography, intraoperative angiography, endoscopy (8 patients), and neuromonitoring. Twenty patients were rated as having a good recovery at 6 months after surgery. No recurrence was observed in any patients during the follow-up (mean, 59.7 months). CONCLUSION: Shunting points of the cervical PMAVS were predominantly located ventral or ventrolateral to the spinal cord and were often fed by the ASA. Even for ventral lesions, posterior exposure assisted with neuromonitoring and endoscopy, and intraoperative angiography provided a view sufficient to understand the relationships between the shunts and the ASA and contributed to good surgical outcomes.

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