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Prenatal surgery for spina bifida: a therapeutic dilemma. Proceedings of the SHINE conference, Belfast

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Abstract

This is a transcript of a scientific conference on the subject of prenatal surgery for spina bifida. It represents the views of three patients, an obstetrician, a postnatal neurosurgeon, a neonatologist, a paediatric neurologist, two surgeons who practice open spina bifida foetal surgery, a fetoscopic surgeon and an obstetrician experienced in randomised trials and systematic reviews. Implications for current practice and recommendations for future research are also discussed in detail.

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References

  1. Adzick NS, Thom EA, Spong CY, Brock JW 3rd, Burrows PK et al (2011) A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 364:993–1004

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Brock JW 3rd, Carr MC, Adzick NS, Burrows PK, Thomas JC et al (2015) Bladder function after fetal surgery for myelomeningocele. Pediatrics 136:e906–e913

    Article  PubMed  PubMed Central  Google Scholar 

  3. Tulipan N, Wellons JC 3rd, Thom EA, Gupta N, Sutton LN et al (2015) Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement. J Neurosurg Pediatr 16:613–620

    Article  PubMed  PubMed Central  Google Scholar 

  4. Zamlynski J, Olejek A, Koszutski T, Ziomek G, Horzelska E et al (2014) Comparison of prenatal and postnatal treatments of spina bifida in Poland--a non-randomized, single-center study. J Matern Fetal Neonatal Med 27:1409–1417

    Article  PubMed  Google Scholar 

  5. Kohl T (2014) Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta. Part I: surgical technique and perioperative outcome. Ultrasound Obstet Gynecol 44:515–524

    Article  PubMed  CAS  Google Scholar 

  6. Degenhardt J, Schurg R, Winarno A, Oehmke F, Khaleeva A et al (2014) Percutaneous minimal-access fetoscopic surgery for spina bifida aperta. Part II: maternal management and outcome. Ultrasound Obstet Gynecol 44:525–531

    Article  PubMed  CAS  Google Scholar 

  7. Herrera SR, Leme RJ, Valente PR, Caldini EG, Saldiva PH, Pedreira DA (2012) Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep. Einstein (Sao Paulo) 10:455–461

    Article  Google Scholar 

  8. Graf K, Kohl T, Neubauer BA, Dey F, Faas D et al (2016) Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta. Part III: neurosurgical intervention in the first postnatal year. Ultrasound Obstet Gynecol 47:158–161

    Article  PubMed  CAS  Google Scholar 

  9. Verbeek RJ, Heep A, Maurits NM, Cremer R, Hoving EW et al (2012) Fetal endoscopic myelomeningocele closure preserves segmental neurological function. Dev Med Child Neurol 54:15–22

    Article  PubMed  Google Scholar 

  10. Sival DA, Guerra M, den Dunnen WF, Batiz LF, Alvial G et al (2011) Neuroependymal denudation is in progress in full-term human foetal spina bifida aperta. Brain Pathol 21:163–179

    Article  PubMed  CAS  Google Scholar 

  11. Ovaere C, Eggink A, Richter J, Cohen-Overbeek TE, Van Calenbergh F et al (2015) Prenatal diagnosis and patient preferences in patients with neural tube defects around the advent of fetal surgery in Belgium and Holland. Fetal Diagn Ther 37:226–234

    Article  PubMed  Google Scholar 

  12. Joyeux L, Engels AC, Russo FM, Jimenez J, Van Mieghem T et al (2016) Fetoscopic versus open repair for spina bifida Aperta: a systematic review of outcomes. Fetal Diagn Ther 39:161–171

    Article  PubMed  Google Scholar 

  13. Morris RK, Malin GL, Khan KS, Kilby MD (2010) Systematic review of the effectiveness of antenatal intervention for the treatment of congenital lower urinary tract obstruction. BJOG 117:382–390

    Article  PubMed  CAS  Google Scholar 

  14. Roberts D, Gates S, Kilby M, Neilson JP (2008) Interventions for twin-twin transfusion syndrome: a Cochrane review. Ultrasound Obstet Gynecol 31:701–711

    Article  PubMed  CAS  Google Scholar 

  15. Senat MV, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y (2004) Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med 351:136–144

    Article  PubMed  CAS  Google Scholar 

  16. Morris RK, Malin GL, Quinlan-Jones E, Middleton LJ, Hemming K et al (2013) Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial. Lancet 382:1496–1506

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors wish to thank the women that agreed to be interviewed at this conference. The authors also wish to thank Mrs. Cathy McKillop from SHINE, the spina bifida charity, for facilitating and organising this meeting. We wish to thank Professor Thomas Kohl for his invaluable contribution regarding fetoscopic surgery at this meeting.

Funding

MDI Medical, Public Health Agency Northern Ireland, Perinatal Trust Fund Northern Ireland, SHINE.

Author information

Authors and Affiliations

Authors

Contributions

SO confirms that this is an honest, accurate and transparent account of the meeting being reported. SO, CM and JC organised the meeting with others. AA wrote the first draft of the report. CB, KAE, JB, AP, AxH, DAS, AH, RM, JD and RKM presented data to the meeting. FM, MS, FMcA, DC and ZA chaired and directed discussion during the meeting. All authors contributed to the discussion, edited the report and approved the final version.

Corresponding author

Correspondence to Stephen Ong.

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Conflict of interest

JB and JD are proponents of prenatal surgery, and DC, MS and RM are proponents of postnatal surgery. These authors do not stand to gain financially or otherwise. All other authors declare no conflict of interest.

Disclosure

This is a transcript of a scientific meeting. Not all authors agree with all statements in this paper.

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Not required.

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Shanmuganathan, M., Sival, D.A., Eastwood, KA. et al. Prenatal surgery for spina bifida: a therapeutic dilemma. Proceedings of the SHINE conference, Belfast. Ir J Med Sci 187, 713–718 (2018). https://doi.org/10.1007/s11845-017-1709-6

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  • DOI: https://doi.org/10.1007/s11845-017-1709-6

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