Fetal Surgery for Spina Bifida Aperta: To Be or Not to Be?

Abstract

Fetal SBA (spina bifida aperta) has been operated upon in more than 213 cases in the USA in the last 8 years. Indications and results still remain controversial. Our group reproduced successfully Meuli's model in sheep and reviewed the literature on SBA and the Internet updated sites on the theme. Then we reviewed the follow-up of all cases operated upon postnatally in 20 years at a Neurosurgery Department in Rome. We published all the data regarding the three above-mentioned steps. This paper contains reflections on the three, and our opinion on the correct approach to prenatally diagnosed SBA, as far as fetal surgery is concerned.

Key words

Fetal surgery - Ethics - Spina bifida aperta - Prenatal diagnosis

References

• 1 Canova A, Patricolo M, Colangeli M. et al . Open spina bifida: A 20 years experience.  Riv Neurobiologia. 1998;  44 19-25
• 2 De Caro G MF, Patricolo M, Meuli. et al .Neurochirurgia Fetal e Sperimentale: Terapia Riparativa in Utero della Spina Bifida. Abstract Boock XLVII Congress of the Italian Society of Neurosurgery, 1998; 11/14 October. Trieste; Minerva Medica 1998: 405-407
• 3 Harrison M R, Adzick N S, Evans M I, Holzgreve W. (eds) .The Unborn Patient: The Art and Science of Fetal Therapy. 3rd ed. Philadelphia, PA; W. B. Saunders 2000
• 4 Harrison M R, Adzick N S, Jennings R W, Duncan B W, Rosen M A, Filly R A, Goldberg J D, de Lorimier A A, Golbus M S. Antenatal intervention for congenital cystic adenomatoid malformation.  Lancet. 1990;  336 965-967
• 5 Harrison M R, Adzick N S. The fetus as a patient. Surgical considerations.  Ann Surg. 1991;  213 279-291
• 6 Hirose S, Farmer D L, Albanese C T. Fetal surgery for myelomeningocele.  Curr Opin Obstet Gynecol. 2001;  13 215-222
• 7 Holmes N, Harrison M R, Baskin L S. Fetal surgery for posterior urethral valves: long-term postnatal outcomes.  Pediatrics. 2001;  108 E7
• 8 Holzbeierlein J, Pope J C, Adams M C, Bruner J, Tulipan N, Brock J W. The urodynamic profile of myelodysplasia in childhood with spinal closure during gestation.  J Urol. 2000;  164 1336-1339
• 9 Hutchins G M, Meuli M, Meuli-Simmen C. et al . Acquired spinal cord injury in human fetuses with myelomeningocele.  Pediatr Pathol Lab Med. 1996;  16 701-712
• 10 Liley A W. Fetal transfusion.  Bibl Haematol. 1965;  23 929-932
• 11 Lyerly A D, Gates E A, Cefalo R C, Sugarman J. Towards the ethical evaluation and use of maternal fetal surgery.  Obstet Gynecol. 2001;  98 689-697
• 12 MacKenzie T C, Crombleholme T M, Flake A W. The ex-utero intrapartum treatment.  Curr Opin Pediatr. 2002;  14 453-458
• 13 Meuli M, Meuli-Simmen C, Yingling C D, Hutchins G M, Timmel G B, Harrison M R, Adzick N S. In utero repair of experimental myelomeningocele saves neurological function at birth.  J Pediatr Surg. 1996;  31 397-402
• 14 Noetzel M J. Myelomeningocele: Current concepts of management.  Clin Perinatol. 1988;  16 311-327
• 15 Noia G, De Santis M, Mastromarino C, Trivellini C, Romano D, Caruso A, Mancuso S. Double shunt in a case of fetal low-level obstructive uropathy.  Fetal Diagn Ther. 1996;  11 313-317
• 16 Noia G, De Santis M, Tocci A, Maussier M L, D'Errico G, Bianchi A, Romagnoli C, Masini L, Caruso A, Mancuso S. Early prenatal diagnosis and therapy of fetal hypothyroid goiter.  Fetal Diagn Ther. 1992;  7 138-143
• 17 Pastore F S, Patricolo M, De Caro G MF, Giuffre R. Current state and forthcomings of fetal neurosurgery.  Ann Ital Chir. 1998;  3 295-301
• 18 Patricolo M, Noia G, Rossi L, Zangari A, Pomini F, Catesini C, Filippetti R, Galli T, Iacobelli B D, Capuano L G, Romano D, Mancuso S, Rivosecchi M. An experimental animal model of intestinal obstruction to simulate in utero therapy for jejunoileal atresia.  Fetal Diagn Ther. 1998;  13 298-301
• 19 Patricolo M, Rivosecchi M. Chirurgia fetale sperimentale. Noia G, Caruso A, Mancuso S Terapia Fetali Invasiva. Roma; SEU 1998: 350-414
• 20 Patricolo M, Zangari A, Paolocci N, Magni F, Viola-Magni M P, Hernandez-Mena L A, Rivosecchi M. In utero partial liver resection in the rabbit model: A study on fetal tissue regeneration.  Fetal Diagn Ther. 1997;  12 232-235
• 21 Silverman M E. Andrea Vesalius and de humani corporis fabrica.  Clin Cardiol. 1991;  14 276-279
• 22 Simon E M, Goldstein R B, Coakley F V, Filly R A, Broderick K C, Musci T J, Barkovich A J. Fast MR imaging of fetal CNS anomalies in utero.  Am J Neuroradiol. 2000;  21 1688-1698
• 23 van Stratten H W, Copp A J. Curly tail: a 50-year history of the mouse spina bifida model.  Anat Embryol. 2001;  203 225-237