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Fetoscopic Myelomeningocele Repair with Complete Release of the Tethered Spinal Cord Using a Three-Port Technique: Twelve-Month Follow-Up—A Case Report

Open spina bifida is one of the most common congenital defects of the central nervous system. Open fetal surgery, which is one of the available therapeutic options, remains the gold standard for prenatal repairs. Fetoscopic closure may lower the number of maternal complications associated with open...

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Autores principales: Pastuszka, Agnieszka, Zamłyński, Mateusz, Horzelski, Tomasz, Zamłyński, Jacek, Horzelska, Ewa, Maruniak-Chudek, Iwona, Marzec, Adrianna, Paprocka, Justyna, Gazy, Patrycja, Koszutski, Tomasz, Olejek, Anita
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9776674/
https://www.ncbi.nlm.nih.gov/pubmed/36552985
http://dx.doi.org/10.3390/diagnostics12122978
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author Pastuszka, Agnieszka
Zamłyński, Mateusz
Horzelski, Tomasz
Zamłyński, Jacek
Horzelska, Ewa
Maruniak-Chudek, Iwona
Marzec, Adrianna
Paprocka, Justyna
Gazy, Patrycja
Koszutski, Tomasz
Olejek, Anita
author_facet Pastuszka, Agnieszka
Zamłyński, Mateusz
Horzelski, Tomasz
Zamłyński, Jacek
Horzelska, Ewa
Maruniak-Chudek, Iwona
Marzec, Adrianna
Paprocka, Justyna
Gazy, Patrycja
Koszutski, Tomasz
Olejek, Anita
author_sort Pastuszka, Agnieszka
collection PubMed
description Open spina bifida is one of the most common congenital defects of the central nervous system. Open fetal surgery, which is one of the available therapeutic options, remains the gold standard for prenatal repairs. Fetoscopic closure may lower the number of maternal complications associated with open fetal surgery. Regardless of the approach, the outcome may be compromised by the development of tethered spinal cord (TSC) syndrome. At 24.2 weeks of gestation, a primipara was admitted due to fetal myelomeningocele and was deemed eligible for fetoscopic repair. Fetal surgery was performed at 25.0 weeks of gestation. It was the first complete untethering of the spinal cord and anatomic reconstruction (dura mater, spinal erectors, skin) achieved during a fetoscopic repair of spina bifida. Cesarean section due to placental abruption was performed at 31.1 weeks of gestation. VP shunting, with no need for revision, was performed at 5 weeks postdelivery due to progressing ventriculomegaly. No clinical or radiological signs of secondary tethering were observed. Neurological examination at 11 months postdelivery revealed cranial nerves without any signs of damage, axial hypotonia, decreased muscle tone in the lower extremities, and absent pathological reflexes. Motor development was slightly retarded. Complete untethering of the neural structures should always be performed, regardless of the surgical approach, as it is the only course of action that lowers the risk for developing secondary TSC.
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spelling pubmed-97766742022-12-23 Fetoscopic Myelomeningocele Repair with Complete Release of the Tethered Spinal Cord Using a Three-Port Technique: Twelve-Month Follow-Up—A Case Report Pastuszka, Agnieszka Zamłyński, Mateusz Horzelski, Tomasz Zamłyński, Jacek Horzelska, Ewa Maruniak-Chudek, Iwona Marzec, Adrianna Paprocka, Justyna Gazy, Patrycja Koszutski, Tomasz Olejek, Anita Diagnostics (Basel) Case Report Open spina bifida is one of the most common congenital defects of the central nervous system. Open fetal surgery, which is one of the available therapeutic options, remains the gold standard for prenatal repairs. Fetoscopic closure may lower the number of maternal complications associated with open fetal surgery. Regardless of the approach, the outcome may be compromised by the development of tethered spinal cord (TSC) syndrome. At 24.2 weeks of gestation, a primipara was admitted due to fetal myelomeningocele and was deemed eligible for fetoscopic repair. Fetal surgery was performed at 25.0 weeks of gestation. It was the first complete untethering of the spinal cord and anatomic reconstruction (dura mater, spinal erectors, skin) achieved during a fetoscopic repair of spina bifida. Cesarean section due to placental abruption was performed at 31.1 weeks of gestation. VP shunting, with no need for revision, was performed at 5 weeks postdelivery due to progressing ventriculomegaly. No clinical or radiological signs of secondary tethering were observed. Neurological examination at 11 months postdelivery revealed cranial nerves without any signs of damage, axial hypotonia, decreased muscle tone in the lower extremities, and absent pathological reflexes. Motor development was slightly retarded. Complete untethering of the neural structures should always be performed, regardless of the surgical approach, as it is the only course of action that lowers the risk for developing secondary TSC. MDPI 2022-11-28 /pmc/articles/PMC9776674/ /pubmed/36552985 http://dx.doi.org/10.3390/diagnostics12122978 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Pastuszka, Agnieszka
Zamłyński, Mateusz
Horzelski, Tomasz
Zamłyński, Jacek
Horzelska, Ewa
Maruniak-Chudek, Iwona
Marzec, Adrianna
Paprocka, Justyna
Gazy, Patrycja
Koszutski, Tomasz
Olejek, Anita
Fetoscopic Myelomeningocele Repair with Complete Release of the Tethered Spinal Cord Using a Three-Port Technique: Twelve-Month Follow-Up—A Case Report
title Fetoscopic Myelomeningocele Repair with Complete Release of the Tethered Spinal Cord Using a Three-Port Technique: Twelve-Month Follow-Up—A Case Report
title_full Fetoscopic Myelomeningocele Repair with Complete Release of the Tethered Spinal Cord Using a Three-Port Technique: Twelve-Month Follow-Up—A Case Report
title_fullStr Fetoscopic Myelomeningocele Repair with Complete Release of the Tethered Spinal Cord Using a Three-Port Technique: Twelve-Month Follow-Up—A Case Report
title_full_unstemmed Fetoscopic Myelomeningocele Repair with Complete Release of the Tethered Spinal Cord Using a Three-Port Technique: Twelve-Month Follow-Up—A Case Report
title_short Fetoscopic Myelomeningocele Repair with Complete Release of the Tethered Spinal Cord Using a Three-Port Technique: Twelve-Month Follow-Up—A Case Report
title_sort fetoscopic myelomeningocele repair with complete release of the tethered spinal cord using a three-port technique: twelve-month follow-up—a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9776674/
https://www.ncbi.nlm.nih.gov/pubmed/36552985
http://dx.doi.org/10.3390/diagnostics12122978
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