59.16 Simplified Prenatal Coverage of Fetal Myelomeningocele with Biosurgical Sealant in Sheep Model

Posted on December 22, 2014

J. L. Peiro1,2, J. Orellana2, S. G. Keswani1, M. Marotta1,2, M. Aguirre2, F. Soldado2, C. G. Fontecha2  1Cincinnati Children’s Hospital Medical Center,The Center For Fetal, Cellular And Molecular Therapy – Pediatric Surgery Division,Cincinnati, OH, USA 2Vall D’Hebron Research Institute (VHIR),Bioengineering, Orthopedics And Pediatric Surgery Group,Barcelona, BARCELONA, Spain

Introduction:  

Myelomeningocele (MMC) is the most frequent non-lethal congenital malformation of the central nervous system, appearing in 1 in every 2000 babies. It is characterized by a deficit of closure of the posterior part of the spine, causing neural tissue exposure to the intrauterine environment, which causes a loss of cerebrospinal fluid and a mechanical-chemical injury on the neural tissue exposed. The closure of the defect by intrauterine open fetal surgery repair has shown better results than the postnatal treatment. Simplified techniques are seeking to enable this repair by fetoscopic approach. Our aim is to assess whether a simple technique of coverage with a biosurgical sealant achieves complete closure and produces the same neural protection as the classic technique of fetal MMC repair.

Methods:

Twenty fetal lambs underwent a surgically like-myelomeningocele lumbar defect on the 75th day of gestation. Four of them were non-repaired (NR). Eight of them underwent immediate coverage with a synthetic biosurgical sealant  (IC). The other 8 underwent delayed coverage with same sealant on the 95th day (DC). Animals were obtained every week, from 1st to 7th postoperative week by c-section for histological analysis.

Results:

All NR animals showed a wide defect of closure, continuous leakage of cerebrospinal fluid, and histological neural damage. All IC and DC animals showed partial coverage of the defect (30 to 100%), with regeneration of dura-mater, muscle and skin only in the covered segment.

Conclusion:

Synthetic bio-surgical sealant applied  over the MMC spinal defect produces partial closure of the neural tube defect without complete healing after its reabsorption in 4 weeks in the fetal lamb model.