Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep


Autoria(s): Herrera, Silvia Rejane Fontoura; Leme, Ricardo José de Almeida; Valente, Paulo Roberto; Caldini, Élia Garcia; Saldiva, Paulo Hilário Nascimento; Pedreira, Denise Araujo Lapa
Contribuinte(s)

UNIVERSIDADE DE SÃO PAULO

Data(s)

04/11/2013

04/11/2013

2012

Resumo

OBJECTIVE: To compare the classical neurosurgical technique with a new simplified technique for prenatal repair of a myelomeningocelelike defect in sheep. METHODS: A myelomeningocele-like defect (laminectomy and dural excision) was created in the lumbar region on day 90 of gestation in 9 pregnant sheep. Correction technique was randomized. In Group 1 the defect was corrected using the classic neurosurgical technique of three-layer suture (dura mater, muscle and skin closure) performed by a neurosurgeon. In Group 2, a fetal medicine specialist used a biosynthetic cellulose patch to protect the spinal cord and only the skin was sutured above it. Near term (day 132 of gestation) fetuses were sacrificed for pathological analysis. RESULTS: There were two miscarriages and one maternal death. In total, six cases were available for pathological analysis, three in each group. In Group 1, there were adherence of the spinal cord to the scar (meningo-neural adhesion) and spinal cord architecture loss with posterior funiculus destruction and no visualization of grey matter. In Group 2, we observed in all cases formation of a neo-dura mater, separating the nervous tissue from adjacent muscles, and preserving the posterior funiculus and grey matter. CONCLUSION: The new simplified technique was better than the classic neurosurgical technique. It preserved the nervous tissue and prevented the adherence of the spinal cord to the scar. This suggests the current technique used for the correction of spina bifida in humans may need to be reassessed.

Identificador

Einstein (São Paulo),v.10,n.4,p.455-461,2012

1679-4508

http://www.producao.usp.br/handle/BDPI/40220

10.1590/S1679-45082012000400011

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1679-45082012000400011&lng=en&nrm=iso&tlng=en

http://www.scielo.br/scielo.php?script=sci_abstract&pid=S1679-45082012000400011&lng=en&nrm=iso&tlng=en

http://www.scielo.br/scielo.php?script=sci_pdf&pid=S1679-45082012000400011&lng=en&nrm=iso&tlng=en

Idioma(s)

eng

Publicador

Instituto Israelita de Ensino e Pesquisa Albert Einstein

Relação

Einstein (São Paulo)

Direitos

openAccess

Palavras-Chave #Myelomeningocele #Spinal dysraphism #Fetal therapies #Fetoscopy #Sheep #Meningomielocele #Disrafismo espinal #Terapias fetais #Fetoscopia #Ovinos
Tipo

article

original article