Percutaneous fetoscopic patch coverage of spina bifida aperta in the human--early clinical experience and potential.
OBJECTIVE
The current operative approach for fetal repair of spina bifida aperta requires maternal laparotomy and hysterotomy. Following technical feasibility studies in sheep, we performed percutaneous fetoscopic patch coverage of this lesion in 3 human fetuses between 23 + 4 and 25 + 3 weeks of gestation.


RESULTS
Whereas the patch detached in the first case 3 weeks after the procedure, it covered the exposed neural tissue in the 2 other fetuses beyond their delivery. Two of the three children survived, but 1 unexpectedly died from a ventilation problem in its 3rd week of life. In 1 of the 2 survivors, ventriculoperitoneal shunt insertion was delayed.


CONCLUSIONS
Percutaneous fetoscopic patch coverage of spina bifida aperta is feasible in human fetuses and offers a substantial reduction of maternal trauma compared to open fetal repair. Further clinical experience is now required before the efficacy of the new approach to protect the exposed neural tissue from mechanical and chemical damage and to improve hindbrain herniation can be evaluated.
Department of Obstetrics & Prenatal Medicine, German Center for Fetal Surgery & Minimally Invasive Therapy, University of Bonn, Bonn, Germany.
Thomas
T
Kohl
Rudolph
R
Hering
Axel
A
Heep
Carlo
C
Schaller
Bernhard
B
Meyer
Claudia
C
Greive
Gabriele
G
Bizjak
Tim
T
Buller
Patricia
P
Van de Vondel
Wiebke
W
Gogarten
Peter
P
Bartmann
Gisela
G
Knopfle
Ulrich
U
Gembruch
D037881:Aborted Fetus / Q000601:surgery; D005260:Female; D005332:Fetoscopy; D005333:Fetus / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008161:Lumbosacral Region / Q000601:surgery*; D008591:Meningomyelocele / Q000601:surgery; D011138:Polytetrafluoroethylene; D011184:Postoperative Period; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D016137:Spina Bifida Cystica / Q000601:surgery*
D011138:Polytetrafluoroethylene