Journal ArticleDOI
Fetal surgery and stem cell therapy for meningomyelocele.
TLDR
Combination of endoscopic fetal surgery with TRASCET or tissue engineering will be a new vision to achieve to improve the outcome of prenatal intervention in fMMC.Abstract:
Purpose of review To review the advance of maternal--fetal surgery, the research of stem cell transplantation and tissue engineering in prenatal management of fetal meningomyelocele (fMMC). Recent findings Advance in the imaging study provides more accurate assessment of fMMC in utero. Prenatal maternal--fetal surgery in fMMC demonstrates favourable postnatal outcome. Minimally invasive fetal surgery minimizes uterine wall disruption. Endoscopic fetal surgery is performed via laparotomy-assisted or entirely percutaneous approach. The postnatal outcome for open and endoscopic fetal surgery shares no difference. Single layer closure during repair of fMMC is preferred to reduce postnatal surgical intervention. All maternal--fetal surgeries impose anesthetic and obstetric risk to pregnant woman. Ruptured of membrane and preterm delivery are common complications. Trans-amniotic stem cell therapy (TRASCET) showed potential tissue regeneration in animal models. Fetal tissue engineering with growth factors and dura substitutes with biosynthetic materials promote spinal cord regeneration. This will overcome the challenge of closure in large fMMC. Planning of the maternal--fetal surgery should adhere to ethical framework to minimize morbidity to both fetus and mother. Summary Combination of endoscopic fetal surgery with TRASCET or tissue engineering will be a new vision to achieve to improve the outcome of prenatal intervention in fMMC.read more
Citations
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Journal ArticleDOI
Subsequent Pregnancy Outcomes After Open Maternal-Fetal Surgery for Myelomeningocele
William Goodnight,Ozan M. Bahtiyar,Kelly A. Bennett,Stephen P. Emery,Joseph B. Lillegard,Allan J. Fisher,Ruth B. Goldstein,Jillian Jatres,Foong-Yen Lim,Laurence B. McCullough,Ueli Moehrlen,Julie S. Moldenhauer,Anita J. Moon-Grady,Rodrigo Ruano,Daniel W. Skupski,Elizabeth Thom,Marjorie C. Treadwell,K. Tsao,Amy J. Wagner,Lindsay N. Waqar,Michael V. Zaretsky +20 more
TL;DR: Compared with delayed clamping, cord milking yielded similar effects on hematocrit concentrations, rates of necrotizing enterocolits, and intraventricular hemorrhage, and need for neonatal transfusions, and did not carry any increased risk of complications.
Journal ArticleDOI
Hydrogel and neural progenitor cell delivery supports organotypic fetal spinal cord development in an ex vivo model of prenatal spina bifida repair.
Juan C. Biancotti,Kendal A. Walker,Guihua Jiang,Julie Di Bernardo,Lonnie D. Shea,Shaun M. Kunisaki +5 more
TL;DR: The biocompatibility of fibrin hydrogel patches on the fetal spinal cord is demonstrated and this organotypic slice culture system is suggested as a useful platform for evaluating mechanisms of damage and repair in children with neural tube defects.
A Comparison Between Placental and Amniotic Mesenchymal Stem Cells for Trans-Amniotic Stem Cell Therapy (TRASCET) in Experimental Spina Bifida
TL;DR: Both pMSC and afMSC can induce comparable rates of coverage of experimental spina bifida after concentrated intraamniotic injection in the rodent model, which broadens the options for timing and cell source for TRASCET as a potential alternative in the prenatal management of spina Bifida.
Journal ArticleDOI
Prenatal Neural Tube Anomalies: A Decade of Intrauterine Stem Cell Transplantation Using Advanced Tissue Engineering Methods
Alireza Soltani Khaboushan,Mehdi Shakibaei,Abdol-Mohammad Kajbafzadeh,Masoumeh Majidi Zolbin +3 more
TL;DR: In this article, the authors discuss advanced tissue engineering (TE) methods for treating myelomeningocele (MMC) and recent successes in increasing the efficacy of the treatment.
Journal ArticleDOI
Intrauterine fetoscopic closure of myelomeningocele: Clinical case and literature review
Jelena Volochovič,Brigita Vaigauskaitė,Povilas Varnelis,Przemyslaw Kosinski,Miroslaw Wielgos +4 more
TL;DR: In this paper, a 32-year-old multigravida whose fetus was diagnosed with lumbosacral myelomeningocele at 23rd week was performed at 26 weeks.
References
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Journal ArticleDOI
A Randomized Trial of Prenatal versus Postnatal Repair of Myelomeningocele
N. Scott Adzick,Elizabeth Thom,Catherine Y. Spong,John W. Brock,Pamela K. Burrows,Mark P. Johnson,Lori J. Howell,Jody A. Farrell,Mary E. Dabrowiak,Leslie N. Sutton,Nalin Gupta,Noel Tulipan,Diana L. Farmer +12 more
TL;DR: Prenatal surgery for myelomeningocele reduced the need for shunting and improved motor outcomes at 30 months but was associated with maternal and fetal risks and increased risk of preterm delivery and uterine dehiscence at delivery.
Journal ArticleDOI
Fetoscopic Open Neural Tube Defect Repair: Development and Refinement of a Two-Port, Carbon Dioxide Insufflation Technique.
Michael A. Belfort,William E. Whitehead,Alireza A. Shamshirsaz,Zhoobin H. Bateni,Oluyinka O. Olutoye,Olutoyin A. Olutoye,David G. Mann,Jimmy Espinoza,Erin Williams,Timothy C. Lee,Sundeep G. Keswani,Nancy Ayres,Christopher I. Cassady,Amy R. Mehollin-Ray,Magdalena Sanz Cortes,Elena Carreras,Jose L. Peiro,Rodrigo Ruano,Darrell L. Cass +18 more
TL;DR: Fetoscopic open neural tube defect repair does not appear to increase maternal-fetal complications as compared with repair by hysterotomy, allows for vaginal delivery, and may reduce long-term maternal risks.
Journal ArticleDOI
Fetal myelomeningocele: natural history, pathophysiology, and in-utero intervention
TL;DR: Preliminary results suggest that fetal surgery results in reversal of hindbrain herniation, a decrease in shunt-dependent hydrocephalus, and possibly improvement in leg function, but these findings might be explained by selection bias and changing management indications.
Journal ArticleDOI
Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial
Denise Araújo Lapa Pedreira,Nelci Zanon,Koshiro Nishikuni,Renato A. Moreira de Sá,G.L. Acacio,Ramen H. Chmait,Eftichia V. Kontopoulos,Rubén A. Quintero +7 more
TL;DR: This study suggests that the antenatal treatment of OSB using a fetoscopic approach and a unique surgical technique can result in a watertight seal, reversal of the hindbrain herniation, and better than expected motor function.
Journal ArticleDOI
The Management of Myelomeningocele Study: full cohort 30-month pediatric outcomes.
Diana L. Farmer,Diana L. Farmer,Elizabeth Thom,John W. Brock,Pamela K. Burrows,Mark P. Johnson,Lori J. Howell,Jody A. Farrell,Nalin Gupta,N. Scott Adzick +9 more
TL;DR: The data for the full cohort of 183 patients corroborate the original findings of Management of Myelomeningocele Study, confirming that prenatal repair improves the primary outcome composite score of mental development and motor function.