Abstract
Introduction: Foetal surgical repair of myelomeningo-cele protects the spinal cord and prevents the development of Chiari malformation and hydrocephalus. The procedure needs manipulation of the fragile foetal tissues and tension free closure of the skin.
With translational purposes, since January 2004 we have developed a novel foetal procedure in a sheep model that avoids foetal tissue manipulation. The technique consists in a gentle coverage of the defect using an inert patch sheet secured by a surgical sealant. results in the animal model showed adequate protection of the spinal cord and prevention of the Chiari malformation. Later on, this technique has been used in two human foetuses.
Case 1: Female foetus 24 weeks old. Lumbar myelo-meningocele, spontaneous mobility of the legs, mild ventricular dilatation, previous c-section and posterior placenta.
Foetal repair was done in August 2008 by means of closure of the dural sac and coverage with a patch of collagen-elastin matrix) secured with surgical sealant.
Birth delivery happened at 31 weeks due to uterine rupture in the scar from a previous c-section. At birth, the newborn weighted 1.5Kg, and showed a complete closure of the defect without leakage of cerebrospinal fluid, and normal legs mobility. Cranial MRI showed small cerebelar herniation and small ventricular dilatation. One year after birth the baby is able to walk, but the ventricular dilatation has progressed and a shunt was placed on at 11 months of life.
Case 2: Male foetus 23 weeks old. Lumbosacral defect, spontaneous mobility of the legs, mild ventricular dilatation, cerebelar herniation, previous c-section and anterior placenta.
Foetal repair was made in January 2009 by means of closure of the dural sac and coverage with a patch secured with surgical sealant.
Birth delivery was done at 30 weeks due to oligoamnios. At birth the newborn weighted 1Kg, and showed closure of the defect without leakage of cerebrospinal fluid, and normal legs mobility. Cranial MRI showed correction of the Chiari malformation and no ventricular dilatation. Eight months after birth the baby is fine and stable.
Conclusion: Surgical foetal coverage of myelomenin-gocele using inert patch and surgical sealant is a fast and gentle procedure for the foetus that avoids tissue manipulation, enhances closure of the defect and prevents Chiari malformation and hydrocephalus.
Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Tel: +41 44 448 44 00; Email: office@efort.org
Author: Cesar Fontecha, Spain
E-mail: cgarcia@ir.vhebron.net
