Fetoscopic patch coverage of experimental myelomenigocele using a two-port access in fetal sheep

Childs Nerv Syst. 2017 Jul;33(7):1177-1184. doi: 10.1007/s00381-017-3461-7. Epub 2017 May 26.


Purpose: This study aims to assess the feasibility and the effectiveness of a fetoscopic myelomeningocele (MMC) coverage using a sealed inert patch through a two-port access, in the sheep model.

Methods: Forty-four fetuses underwent surgical creation of a MMC defect at day 75 and were divided into four groups according to the MMC repair technique, performed at day 90. Group 1 remained untreated. Group 2 had an open surgery using suture of the defect. Groups 3 and 4 underwent defect coverage using a Gore®-polytetrafluoroethylene patch secured with surgical adhesive (Bioglue®), with an open approach (group 3) and a fetoscopic one (group 4). Lambs were killed at term, and histological examinations were performed.

Results: Fetoscopic patch coverage was achieved in all the lambs of group 4. All the fetuses of group 2 had a complete closure of the defect whereas only 38% in group 3 and 14% in group 4. Fetal loss rate seems to be lower in group 4 than in groups 2 and 3.

Conclusion: Fetoscopic coverage of MMC defect can be performed using a sealed patch through a two-port access, but the patch and glue correction may not be the ideal technique to repair fetal MMC.

Keywords: Fetal surgery; Fetal therapy; Fetoscopy; Open spina bifida; Sheep.

MeSH terms

  • Animals
  • Disease Models, Animal
  • Female
  • Fetal Diseases / diagnosis*
  • Fetal Diseases / surgery*
  • Fetoscopy*
  • Fetus
  • Meningomyelocele / diagnosis*
  • Meningomyelocele / surgery*
  • Neurosurgical Procedures / methods*
  • Pregnancy
  • Pregnancy Complications / diagnosis
  • Pregnancy Complications / physiopathology
  • Prenatal Care
  • Sheep