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Percutaneous fetoscopic patch closure of human spina bifida aperta: advances in fetal surgical techniques may obviate the need for early postnatal neurosurgical intervention

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Abstract

Background

A percutaneous minimally invasive fetoscopic approach was attempted for closure of a spina bifida aperta in two fetuses with L5 lesions. The goal was to obviate the need for postnatal neurosurgery to manage this condition.

Methods and Results

The percutaneous fetoscopic procedures were performed by a two-layer approach at respectively 22 ± 2 and 22 ± 4 weeks of gestation. The fetuses were delivered respectively at 32 ± 6 and 32 + 3 weeks of gestation. Their neural cords were completely covered although in small areas skin closure was incomplete. Postnatally, complete skin closure occurred beneath an occlusive draping within 2 to 3 weeks such that neurosurgical intervention was not required. Both neonates showed reversal of hindbrain herniation, near-normal leg function, and satisfactory bladder and bowel function. For one of the two fetuses, ventriculoperitoneal shunt insertion was not required.

Conclusions

Percutaneous minimally invasive fetoscopic patch closure of spina bifida aperta offers a substantially less maternal trauma than open fetal surgical repair and currently may even obviate the need for postnatal neurosurgical repair. With a little further improvement in surgical techniques and a better understanding of incorporating surgical patches into the fetus, complete skin closure seems possible in the near future.

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Acknowledgments

The development of the minimally invasive fetoscopic technique has been supported by educational and research grants Ko 1484/1-1, Ko 1484/2-1, Ko 1484/3-1, Ko 1484/3-2, Ko 1484/3-3 of the Deutsche Forschungsgemeinschaft (DFG), Bonn, Germany.

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Authors and Affiliations

  1. Department of Obstetrics and Prenatal Medicine, German Center for Fetal Surgery & Minimally-Invasive Therapy, University of Bonn, Sigmund Freud Str. 25, 53105, Bonn, Germany

    Thomas Kohl, Kristina Tchatcheva, Waltraut Merz, Rüdiger Stressig & Ulrich Gembruch

  2. Department of Cardiology, University Children’s Hospital Münster, 48149, Munster, Germany

    Thomas Kohl

  3. Department of Anesthesiology, University of Bonn, 53105, Bonn, Germany

    Hans C. Wartenberg

  4. Department of Neonatology, University of Bonn, 53105, Bonn, Germany

    Axel Heep, Andreas Müller & Axel Franz

  5. Department of Radiology, University of Bonn, 53105, Bonn, Germany

    Winfried Willinek

Authors
  1. Thomas Kohl
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  2. Kristina Tchatcheva
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  3. Waltraut Merz
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  4. Hans C. Wartenberg
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  5. Axel Heep
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  6. Andreas Müller
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  7. Axel Franz
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  8. Rüdiger Stressig
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  9. Winfried Willinek
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  10. Ulrich Gembruch
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Corresponding author

Correspondence to Thomas Kohl.

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Kohl, T., Tchatcheva, K., Merz, W. et al. Percutaneous fetoscopic patch closure of human spina bifida aperta: advances in fetal surgical techniques may obviate the need for early postnatal neurosurgical intervention. Surg Endosc 23, 890–895 (2009). https://doi.org/10.1007/s00464-008-0153-0

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  • DOI: https://doi.org/10.1007/s00464-008-0153-0

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