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Oral Concurrent Session 5 - Fetal Genetics and Ultrasound
Oral Concurrent Sessions
Expedited Sessions
Cryopreserved HUC has a regenerative matrix with anti-inflammatory and anti-scarring properties, which regenerates the arachnoid layer and improves spinal cord function. Here, we establish the feasibility of performing a fMMC-HUC meningeal closure followed by primary skin closure and compare it to oMMC repair.
Study Design:
Under a single-arm interventional FDA investigational device exemption and IRB approved protocol, we offered fMMC-HUC to patients who were candidates for oMMC. The surgical approach was laparotomy-assisted via 3 ports (5 mm, 16 Fr and 9 Fr), with anchored fetal membranes, and it was performed under heated-humified carbon dioxide at a gestational age (GA) of 24–256/7 weeks. Following placode dissection, the HUC patch was circumferentially sutured (4-O Stratafix), followed by skin closure. Three independent pediatric neurosurgeons assessed the primary outcome of successful closure by image review (Figure 1; majority vote). Outcomes were compared to our prospective cohort of oMMC repairs.
Results:
Overall, 25/28 consented to study participation. One patient’s procedure was terminated after laparotomy due to a hypertonic uterus, despite multiple relaxants. There were no conversions to open repair. The primary outcome was successful in all 24 fMMC-HUC repairs. There were no significant differences in the maternal demographics, gestational age at evaluation, or pre-operative ventricular size. The total operative time and fetal surgical time was 2 hours longer in the fMMC-HUC group versus oMMC repair. There was no difference in preterm premature rupture of membranes and GA at delivery. fMMC-HUC repair cases could deliver vaginally (58%). There was no cerebrospinal fluid leakage in the fMMC-HUC group compared to 5% in the oMMC group, but it did not reach statistical difference.
Conclusion:
Fetoscopic myelomeningocele repair using the HUC as a meningeal patch is feasible, having comparable neonatal short-term outcomes when compared to open in-utero repair. Vaginal delivery was possible in the majority of fetoscopically repaired patients.
Ramesha Papanna, MD, MPH
Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Stephen A. Fletcher, DO
Neurosurgery, Pediatric Neurosurgery
Pediatric Neurosurgery, Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Lovepreet Mann, MBBS
Division of Maternal-Fetal Medicine, The Fetal Center at Children's Memorial Hermann Hospital, Department of Obstetrics, Gynecology and Reproductive Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Jeannine Garnett, PhD (she/her/hers)
Program Manager, Research - Ob/Gyn Maternal Fetal Medicine
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, TX, United States
Eric P. Bergh, MD
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Mary Austin, MD
Pediatric Surgeon
Pediatric Surgery and Pediatric Surgical Critical Care McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Brandon Miller, MD, PhD
Assistant Professor, Division Of Pediatric Neurosurgery
UT Health Houston McGovern Medical School
Houston, Texas, United States
Jerrie Refuerzo, MD
Associate Professor
University of Texas Health Science Center at Houston
Houston, Texas, United States
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Anthony Johnson, DO
Professor
Division of Fetal Intervention, The Fetal Center at Children's Memorial Hermann Hospital, Department of Obstetrics, Gynecology and Reproductive Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Ranu Jain, MD
McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Kuojen Tsao, MD
Chief of Pediatric Surgery
Pediatric Surgery and Pediatric Surgical Critical Care McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States