The impact of a biocellulose-based repair of fetal open spina bifida on the need to untether the cord: is it time to unify techniques for prenatal repair?

IF 1.1 Q2 MEDICINE, GENERAL & INTERNAL
Einstein-Sao Paulo Pub Date : 2024-04-26 eCollection Date: 2024-01-01 DOI:10.31744/einstein_journal/2024AO0557
Denise Araújo Lapa, Gustavo Yano Callado, Giulia Catissi, Lucas Trigo, Fernanda Faig-Leite, Ana Paola Arthaud Berthet Sevilla
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Abstract

Objective: To report the need for cord untethering after prenatal repair of open spina bifida using a unique biocellulose-based technique performed at a later gestational age.

Methods: An observational cohort study was conducted to determine the incidence of tethered cord syndrome. Between May 2013 and May 2022, we performed 172 procedures using the percutaneous fetoscopic approach in fetuses at 26-28 weeks of gestation. After placode dissection, a biocellulose patch was placed to cover the placode, a myofascial flap (when possible) was dissected, and the skin was closed. Owing to death or loss to follow-up, 23 cases were excluded. Cord tethering syndrome was defined as symptoms of medullary stretching, and the infants were evaluated and operated on by local neurosurgeons after an magnetic resonance imaging examination. Infants over 30-month had ambulation and neurodevelopment evaluations (PEDI scale).

Results: Among 172 cases operated at a median gestational age of 26.7 weeks and delivered at 33.2 weeks, 149 cases were available for postnatal follow-up, and cord untethering was needed in 4.4% of cases (6/136; excluding 13 cases younger than 12 months). Cerebrospinal fluid diversion and bladder catheterization were needed in 38% and 36% of cases, respectively. Of the 78 cases evaluated at 30 months, 49% were ambulating independently, and 94% had normal social function.

Conclusion: The biocellulose-based technique was associated with a low rate of cord tethering, wich may be attributed to the lack of the duramater suture during prenatal repair, the formation of a neoduramater and/or later gestational age of surgery.

基于生物纤维素的胎儿开放性脊柱裂修复术对脐带松解需求的影响:现在是统一产前修复技术的时候了吗?
目的报告在妊娠晚期使用基于生物纤维素的独特技术对开放性脊柱裂进行产前修复后,是否需要解开脐带:方法: 我们进行了一项观察性队列研究,以确定脐带拴系综合征的发生率。在 2013 年 5 月至 2022 年 5 月期间,我们使用经皮胎儿镜方法为孕 26-28 周的胎儿实施了 172 例手术。胎盘剥离后,放置生物纤维素补片覆盖胎盘,剥离肌筋膜瓣(如有可能)并缝合皮肤。由于死亡或失去随访机会,23 例病例被排除在外。脐带拴系综合征被定义为髓质伸展症状,婴儿在接受磁共振成像检查后由当地神经外科医生进行评估和手术。30个月以上的婴儿接受了行走和神经发育评估(PEDI量表):在中位胎龄26.7周、33.2周分娩的172例手术病例中,有149例进行了产后随访,4.4%的病例(6/136;不包括13例小于12个月者)需要进行脐带松解术。分别有 38% 和 36% 的病例需要进行脑脊液转移术和膀胱导尿术。对 78 例病例进行 30 个月评估后发现,49% 的病例可以独立行走,94% 的病例社会功能正常:结论:基于生物纤维素的技术导致的脐带拴系率较低,这可能是由于产前修复过程中缺少杜拉米特缝合线、新杜拉米特的形成和/或手术妊娠年龄较晚所致。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Einstein-Sao Paulo
Einstein-Sao Paulo MEDICINE, GENERAL & INTERNAL-
CiteScore
2.00
自引率
0.00%
发文量
210
审稿时长
38 weeks
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