Peri- und postoperatives Management von Schwangeren nach minimal-invasiver fetoskopischer Patchabdeckung bei fetaler Spina bifida aperta

Zusammenfassung

Die minimal-invasive fetoskopische Patchabdeckung bei Spina bifida aperta wurde eingeführt, um das nachgeburtliche neurologische Outcome betroffener Feten zu verbessern, dabei aber das mütterliche Trauma durch Verzicht auf Laparotomie und Hysterotomie zu verringern. Die vorliegende Arbeit gibt einen Überblick über das peri- und postoperative Behandlungsmanagement an unserem Zentrum.

Abstract

Minimally invasive fetoscopic surgery for spina bifida has been developed to improve the postnatal neurological function of affected fetuses ­and to achieve a reduced maternal trauma compared to open fetal surgery. This ­article gives an overview on the peri- and postoperative management of such cases at our centre.

Schlüsselwörter

Spina bifida - Fetoskopie - Fetalchirurgie

Key words

Spina bifida - fetoscopy - fetal surgery

• Literatur

• 1 Tulipan N, Bruner JP. Myelomeningocele repair in utero: a report of three cases. Pediatr Neurosurg 1998; 28: 177
• 2 Adzick NS, Sutton LN, Crombleholme TM et al. Successful fetal surgery for spina bifida. Lancet 1998; 352: 1675
• 3 McLone DG, Knepper PA. The cause of the Chiari II malformation: a unified theory. Pediatr Neurosci 1989; 15: 1-12
• 4 Bowman RM, McLone DG, Grant JA et al. Spina bifida outcome. A 25-year prospective. Pediatr Neurosurg 2001; 34: 114-120
• 5 Tulipan N, Hernanz-Schulman M, Bruner JP. Reduced hindbrain herniation after intrauterine myelomeningocele repair: A report of four cases. Pediatric Neurosurg 1998; 29: 274-278
• 6 Bouchard S, Davey MG, Rintoul NE et al. Correction of hindbrain herniation and anatomy of the vermis after in utero repair of myelomeningocele in sheep. Journal of Pediatric Surgery 2003; 38: 451-458
• 7 Bruner JP, Tulipan N. Intrauterine repair of spina bifida. Clin Obstet Gynecol 2005; 48: 942-955
• 8 Adzick NS, Thom EA, Spong CY et al. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 2011; 364: 993-1004
• 9 Bruner JP, Tulipan NB, Richards WO et al. In utero repair of myelomeningocele: a comparison of endoscopy and hysterotomy. Fetal Diagn Ther 2000; 15: 83-88
• 10 Kohl T, Hering R, Heep A et al. Percutaneous fetoscopic patch coverage of spina bifida aperta in the human – Early clinical experience and potential. Fetal Diagn Ther 2006; 21: 185-193
• 11 Hering R, Hoeft a, Putensen C et al. Maternal haemodynamics and lung water content during percutaneous fetoscopic interventions under general anaesthesia. Br J Anaesth 2009; 102: 523-527 DOI: 10.1093/bja/aep016.
• 12 Degenhardt J, Kawecki A, Enzensberger C et al. OP06.04: Minor bleeding events during fetoscopic surgery for spina bifida aperta result in small but hemodynamically not significant increases of fetal MCA peak velocity. Ultrasound Obstet Gynecol 2012; 40: 73
• 13 Degenhardt J, Schürg R, Winarno A et al. Percutaneous minimally-invasive fetoscopic surgery for spina bifida aperta – Part II Maternal management and outcome. Ultrasound Obstet Gynecol 2014; n/a–n/a. DOI: 10.1002/uog.13389.
• 14 Shurtleff D. Fetal endoscopic myelomeningocele repair. Dev Med Child Neurol 2012; 54: 4-5 DOI: 10.1111/j.1469-8749.2011.04141.x.