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Childs Nerv Syst. 2017 Jul;33(7):1177-1184. doi: 10.1007/s00381-017-3461-7. Epub 2017 May 26.

Fetoscopic patch coverage of experimental myelomenigocele using a two-port access in fetal sheep.

Author information

1
Service de Médecine Foetale, Hôpital Armand Trousseau, APHP, 26 avenue du Docteur Arnold Netter, 75012, Paris, France. lucie.guilbaud@gmail.com.
2
Université Pierre et Marie Curie, Paris 6, Paris, France. lucie.guilbaud@gmail.com.
3
Service de Médecine Foetale, Hôpital Armand Trousseau, APHP, 26 avenue du Docteur Arnold Netter, 75012, Paris, France.
4
Université Pierre et Marie Curie, Paris 6, Paris, France.
5
Service d'Histologie-Embryologie et Cytologie, Hôpital Necker-Enfants Malades, APHP, Paris, France.
6
Laboratoire de Neuropathologie, Hôpital Sainte Justine, Montréal, Québec, Canada.
7
Service de Neurochirurgie Pédiatrique, Hôpital Femme Mère Enfant, CHU de Lyon, Lyon, France.
8
Service de Neurochirurgie Pédiatrique, Hôpital Necker-Enfants Malades, APHP, Paris, France.
9
Université René Descartes, Paris 5, Paris, France.

Abstract

PURPOSE:

This study aims to assess the feasibility and the effectiveness of a fetoscopic myelomeningocele (MMC) coverage using a sealed inert patch through a two-port access, in the sheep model.

METHODS:

Forty-four fetuses underwent surgical creation of a MMC defect at day 75 and were divided into four groups according to the MMC repair technique, performed at day 90. Group 1 remained untreated. Group 2 had an open surgery using suture of the defect. Groups 3 and 4 underwent defect coverage using a Gore®-polytetrafluoroethylene patch secured with surgical adhesive (Bioglue®), with an open approach (group 3) and a fetoscopic one (group 4). Lambs were killed at term, and histological examinations were performed.

RESULTS:

Fetoscopic patch coverage was achieved in all the lambs of group 4. All the fetuses of group 2 had a complete closure of the defect whereas only 38% in group 3 and 14% in group 4. Fetal loss rate seems to be lower in group 4 than in groups 2 and 3.

CONCLUSION:

Fetoscopic coverage of MMC defect can be performed using a sealed patch through a two-port access, but the patch and glue correction may not be the ideal technique to repair fetal MMC.

KEYWORDS:

Fetal surgery; Fetal therapy; Fetoscopy; Open spina bifida; Sheep

PMID:
28550526
DOI:
10.1007/s00381-017-3461-7
[Indexed for MEDLINE]

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