Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta: first cases in Turkey

İbrahim Alataş, Hüseyin Canaz, Ali Gedikbaşı, Kerem Özel, Ayten Saraçoğlu, Tolga Saraçoğlu, Nursu Kara, Thomas Kohl

Bilgiler
Özet

Künye

Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta: first cases in Turkey. Perinatoloji Dergisi 2015;23(3):S44 DOI: 10.2399/prn.15.S001084

Yazar Bilgileri

İbrahim Alataş¹,

Hüseyin Canaz¹,

Ali Gedikbaşı²,

Kerem Özel¹,

Ayten Saraçoğlu³,

Tolga Saraçoğlu⁴,

Nursu Kara⁵,

Thomas Kohl⁶

Spina Bifida Research Center, Florence Nightingale Hospital, Istanbul
Department of Perinatology, Kanuni Sultan Süleyman Hospital, İstanbul
Department of Anesthesıology and Reanımation, Florence Nightingale Hospital, Istanbul Bilim Unıversıty, Istanbul
Department of Anesthesıology and Reanımation, Florence Nightingale Hospital, Istanbul Bilim Unıversıty, Istanbul;
Department of Neonatology, Florence Nightingale Hospital, Istanbul Bilim University, Istanbul
German Center for Fetal Minimal Invasive Surgery, Justus Liebig Unıversity, Giessen, Almanya

Yazışma Adresi

İbrahim Alataş, Spina Bifida Research Center, Florence Nightingale Hospital, Istanbul ,

Yayın Geçmişi

Gönderilme Tarihi: 30 Ağustos 2015

Son Revizyon Tarihi: 30 Ağustos 2015

Kabul Edilme Tarihi: 01 Eylül 2015

Erken Baskı Tarihi: 01 Ekim 2015

Çıkar Çakışması

Çıkar çakışması bulunmadığı belirtilmiştir.

Amaç

Myelomeningocele (MMC), one of the most common congenital malformations, can result in severe lifelong disabilities, including paraplegia, hydrocephalus, Chiari II malformation, incontinence, sexual dysfunction, skeletal deformations and mental impairment. MMC was the first nonlethal anomaly to be treated by fetal surgery. The first fetoscopic approaches for spina bifida closure in humans by maternal laparotomy, uterine exteriorization, and transuterine trocar placement were reported in the United States by Bruner et al. and Farmer et al. Both teams abandoned their fetoscopic approaches because early results were disappointing due to technical difficulties. Since then, fetoscopic fetal surgery for spina bifida has been replaced by an open surgical approach performed currently for several hundreds of human fetuses in North America and also for some fetuses in Brazil, Poland, Spain and Switzerland. Percutaneous minimally invasive fetoscopic approach was defined by Thomas Kohl, to minimize maternal trauma from the open fetal surgical approach. Our aim is to present the first two cases of Turkey and their short term results.

Yöntem

Percutaneous fetoscopic patch closure was attempted for repair of myelomeningocele in two fetuses with L5 and L4 lesions respectively, by a surgical team consists of a perinatologist, pediatric neurosurgeon and a pediatric surgeon.

Bulgular

Procedures were performed at 25+2 and 25+4 weeks of gestation, respectively. Follow-up of pregnancies continued for 4 and 5 weeks. Fetuses were delivered at 31+1 and 31+3 weeks of gestation, respectively. Their neural cords were completely covered although in small areas skin closure was incomplete. Complete skin closure occurred beneath an occlusive draping within 4 to 6 weeks.

Sonuç

Both neonates showed reversal of hindbrain herniation, near-normal leg function, and satisfactory bladder and bowel function. Ventriculoperitoneal shunt insertion was not required for both neonates.