Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct;62(4):558-564.
doi: 10.1002/uog.26236. Epub 2023 Sep 12.

Biocellulose patch technique for fetoscopic repair of open spina bifida in twin pregnancy

D A Lapa  1   2 , G L Acácio  2   3 , L Trigo  4   5   6   7 , R T Goncalves  1   8 , G Catissi  1 , B Gato  9 , R Brandt  10
Affiliations
Free article

Biocellulose patch technique for fetoscopic repair of open spina bifida in twin pregnancy

D A Lapa et al. Ultrasound Obstet Gynecol. 2023 Oct.
Free article

Abstract

Objectives: Twin pregnancy is currently an exclusion criterion for prenatal repair of open spina bifida (OSB). The main objective of this study was to report on our experience of treating twin pregnancies with OSB using the skin-over-biocellulose for antenatal fetoscopic repair (SAFER) technique. We also discuss reconsideration of the current exclusion criteria for fetal OSB repair.

Methods: Eight fetuses with OSB from seven twin pregnancies underwent successful prenatal repair. Six pregnancies were dichorionic diamniotic with only one twin affected, and one was monochorionic diamniotic with both twins affected. Percutaneous fetoscopy was performed under CO2 insufflation of the sac of the affected twin. Neurosurgical repair was performed using a biocellulose patch to protect the placode, with the skin sutured to hold the patch in place, with or without a myofascial flap. Neurodevelopment was assessed using the pediatric evaluation of disability inventory scale in babies older than 6 months of adjusted age, whereas the Alberta scale was used for babies younger than 6 months of adjusted age.

Results: All 14 fetuses were liveborn and none required additional repair. Gestational age at surgery ranged from 27.3 to 31.1 weeks, and gestational age at birth ranged from 31.6 to 36.0 weeks. Four out of eight affected twins developed sepsis, but had a good recovery. No sequela of prematurity was found in any of the unaffected twins. Short-term neurodevelopment was normal in all evaluated unaffected twins (5/5) and in all but one affected twins (7/8). In the affected group, only one baby required ventriculoperitoneal shunt placement.

Conclusions: Prematurity is frequent after fetal surgery, and the risk is increased in twin pregnancy. Nevertheless, prenatal surgery using the SAFER technique is feasible, with low risk to both twins and their mother when performed by a highly experienced team. Long-term cognitive assessment of the unaffected twin is needed. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Keywords: discordant dichorionic twins; discordant monochorionic twins; monochorionic twins; myelomeningocele; myeloschisis; open spina bifida cystica; rachischisis; spinal dysraphism.

PubMed Disclaimer

Similar articles

See all similar articles

References

REFERENCES

    1. Adzick N, Thom E, Spong C, Brock III J, Burrows P, Johnson MP, Howeell LJ, Farrell JA, Dabrowiak ME, Sutton LN, Gupta N, Tulipan NB, D'Alton ME, Farmer DL, MOMS Investigators. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 2011; 364: 1959-1968.
    1. Sanz Cortes M, Chmait RH, Lapa DA, Belfort MA, Carreras E, Miller JL, Samaha RBB, Gonzalez GS, Gielchinsky Y, Yamamoto M, Persico N, Santorum M, Otaño L, Nicolaou E, Yinon Y, Faig-Leite F, Brandt R, Whitehead W, Maiz N, Baschat A, Kosinski P, Nieto-Sanjuanero A, Chu J, Kershenovich A, Nicolaides KH. Experience of 300 cases of prenatal fetoscopic open spina bifida repair: report of the International Fetoscopic Neural Tube Defect Repair Consortium. Am J Obstet Gynecol 2021; 225: 678.e1-11.
    1. Sanz Cortes M, Lapa DA, Acacio GL, Belfort M, Carreras E, Maiz N, Peiro JL, Lim FY, Miller J, Baschat A, Sepulveda G, Davila I, Gielchinsky Y, Benifla M, Stirnemann J, Ville Y, Yamamoto M, Figueroa H, Simpson L, Nicolaides KH. Proceedings of the First Annual Meeting of the International Fetoscopic Myelomeningocele Repair Consortium. Ultrasound Obstet Gynecol 2019; 53: 855-863.
    1. Lapa Pedreira DA, Acacio GL, Gonçalves RT, Sá RAM, Brandt RA, Chmait RH, Kontopoulos EV, Quintero RA. Percutaneous fetoscopic closure of large open spina bifida using a bilaminar skin substitute. Ultrasound Obstet Gynecol 2018; 52: 458-466.
    1. Chmait RH, Monson MA, Pham HQ, Chu JK, Van Speybroeck A, Chon AH, Kontopoulos EV, Quintero R. Percutaneous/mini-laparotomy fetoscopic repair of open spina bifida: a novel surgical technique. Am J Obstet Gynecol 2022; 227: 375-383.