title: Single-Access Fetal Endoscopy (SAFE) for myelomeningocele in sheep model I: amniotic carbon dioxide gas approach.
abstract: BACKGROUND
  This study aimed to assess the feasibility of single-access fetal endoscopy (SAFE) for the management of myelomeningocele (MMC) using intrauterine carbon dioxide as a distension medium in a sheep model.
  
  
  METHODS
  This prospective experimental case-control study investigated 12 lamb fetuses that had a myelomeningocele-like defect surgically created on the 75th day of gestation. Four fetuses remained untreated (control group), and eight fetuses had MMC repair using two fetoscopic approaches with carbon dioxide used to distend the amniotic cavity. A collagen patch was placed over the defect and secured with surgical sealant. Four animals had a two-port fetoscopic procedure, and four animals had SAFE. Clinical and pathologic studies were performed after delivery.
  
  
  RESULTS
  This study confirmed the validity of the animal MMC model. None of the control animals was able to stand or walk, and all had a significant defect in the lumbar area with continuous leakage of cerebrospinal fluid, ventriculomegaly, and a Chiari-II malformation. All the treated animals, independently of the number of ports used in the repair, were able to walk and had a closed defect with resolution of the Chiari malformation.
  
  
  CONCLUSIONS
  The SAFE patch and glue coverage of surgically created fetal MMC is feasible and effective in restoring gross neurologic function in the fetal lamb model.
authors.affiliation: Fetal Surgery Program, Congenital Malformations Research Group, Research Institute of Hospital Universitari Vall d'Hebron, Edifici Infantil, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain, bcnpeiro@yahoo.es.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Peiro
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Fontecha
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ruano
authors.forename: Marielle
authors.initials: M
authors.lastname: Esteves
authors.forename: Carla
authors.initials: C
authors.lastname: Fonseca
authors.forename: Mario
authors.initials: M
authors.lastname: Marotta
authors.forename: Sina
authors.initials: S
authors.lastname: Haeri
authors.forename: Michael A
authors.initials: MA
authors.lastname: Belfort
mesh_terms: D000650:Amnion; D000818:Animals; D001139:Arnold-Chiari Malformation / Q000196:embryology / Q000601:surgery; D002245:Carbon Dioxide / Q000008:administration & dosage; D003094:Collagen; D003949:Diagnostic Techniques, Surgical; D005240:Feasibility Studies; D005260:Female; D005332:Fetoscopy / Q000379:methods*; D020007:Implants, Experimental; D007327:Insufflation; D008591:Meningomyelocele / Q000196:embryology / Q000601:surgery*; D023421:Models, Animal; D010641:Phenotype; D011247:Pregnancy; D034561:Sheep, Domestic; D016135:Spinal Dysraphism / Q000196:embryology / Q000601:surgery; D063189:Symptom Assessment; D014014:Tissue Adhesives
chemical_list: D014014:Tissue Adhesives; D002245:Carbon Dioxide; D003094:Collagen