Fetal Endoscopic Surgery for Spina Bifida (FESSB)
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|ClinicalTrials.gov Identifier: NCT03315637|
Recruitment Status : Recruiting
First Posted : October 20, 2017
Last Update Posted : October 20, 2017
|Condition or disease||Intervention/treatment||Phase|
|Neural Tube Defects Spina Bifida, Open Myelomeningocele Fetal Disease Hydrocephalus Chiari Malformation Type 2 Congenital Abnormality Surgery; Maternal, Uterus or Pelvic Organs, Affecting Fetus||Procedure: Fetoscopic repair of spina bifida||Not Applicable|
Spina bifida is a congenital malformation characterized by a failure in neural tube closure. Unprotected fetal neural tissue at the spine level undergoes not only progressive neurodegeneration in spinal cord, but also the impairment in brain development, hindbrain herniation or Chiari II malformation probably due to pressure disturbances resulting from a continuous leakage of cerebrospinal fluid through the defect. The neurological consequences at birth are irreversible and sometimes devastating, including paraplegia, sphincter urinary and fecal incontinence, hydrocephalus, cranial nerve disturbances, respiratory problems and death due to spinal cord injury and brain maldevelopment.
Intrauterine fetal open repair of the defect has proved to improve hindbrain herniation and decrease the need of cerebrospinal shunting.
The investigators hypothesize that minimally invasive surgery of spina bifida is feasible and may minimize surgical aggression and obstetrical complications, with similar neonatal and neurological results.
In this study the investigators propose a fetoscopic skin closure technique. After a maternal laparotomy the uterus is exteriorized, the amniotic cavity is accessed by fetoscopic approach. The placode is dissected from the surrounding tissue and dropped into the opened spinal canal, untethered. Part of the cystic tissue is resected. The edges are then closed to the midline.
After surgery patients are followed up at the Fetal Medicine Unit every one or two weeks.
The mode of delivery is decided according to obstetric criteria. Neonates will be examined at birth, and followed up regularly at least until 30 months. Patients are lifetime followed up by our Multidisciplinary myelomeningocele (MMC) Committee that comprises professionals from the Spina Bifida Unit, Neonatologists, Pediatric Surgeons, Pediatric Urologist, Pediatric Orthopedic Surgeons, Radiologists, Rehabilitation, Pathologists, Pediatric Neurosurgeons, Obstetricians and Fetal Therapists.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||50 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Fetal Endoscopic Surgery for Spina Bifida|
|Actual Study Start Date :||January 2015|
|Estimated Primary Completion Date :||December 31, 2021|
|Estimated Study Completion Date :||December 31, 2024|
Experimental: Fetoscopic repair of spina bifida
This is a single arm study, all patients will receive a fetoscopic repair of the spina bifida
Procedure: Fetoscopic repair of spina bifida
Fetoscopic intrauterine repair of open spina bifida
- Capability to achieve successful closure of the neural tube defect by fetoscopic surgery (yes/no) [ Time Frame: Time of procedure (day 0) ]Binary variable (yes/no) describing if the neural tube defect has been successfully closed, (placode dissected and dropped into the open spinal canal, cystic tissue resected and edges closed to the midline), by fetoscopic surgery, and without conversion to open surgery
- Operating time (minutes) [ Time Frame: Time of procedure (day 0) ]Time between the skin opening and skin closure
- Fetoscopy time (minutes) [ Time Frame: Time of procedure (day 0) ]Time between the introduction of the first cannula and the removal of the last cannula
- Hospital stay (days) [ Time Frame: Between procedure and delivery, up to 21 weeks ]Time between hospital admission and discharge
- Post-operative hemoglobin (g/dL) [ Time Frame: 24 hours after procedure ]Hemoglobin level after the procedure
- Blood transfusion (yes/no) [ Time Frame: Between procedure and discharge, up to 21 weeks ]Binary variable describing if a transfusion of blood derivates is carried out between the time of procedure and discharge
- Gestational age at delivery (weeks and days as x/7) [ Time Frame: At birth, up to 21 weeks after procedure ]Gestational age at birth
- Surgery to delivery interval (days) [ Time Frame: At birth, up to 21 weeks after procedure ]Interval between surgery and birth
- Premature rupture of membranes (PROM) (yes/no) [ Time Frame: Between the procedure and 37 weeks of pregnancy (18 weeks after procedure) ]Binary variable describing amniotic fluid leakage before the onset of labor
- Chorioamnionitis (yes/no) [ Time Frame: Between the procedure and birth, up to 21 weeks after procedure ]Binary variable describing the presence of a chorioamnionitis between the procedure and birth
- Oligohydramnios without PROM (yes/no) [ Time Frame: Between the procedure and birth, up to 21 weeks after procedure ]Binary variable describing the presence of a oligohydramnios (deepest pool < 2 cm) without evidence of vaginal amniotic fluid leakage
- Placental abruption (yes/no) [ Time Frame: Between the procedure and birth, up to 21 weeks after procedure ]Binary variable describing the presence of a placental abruption
- Mode of delivery (vaginal / cesarean) [ Time Frame: At birth, up to 21 weeks after procedure ]Binary variable describing the mode of delivery, vaginal or cesarean section
- Uterine dehiscence (yes/no) [ Time Frame: At birth, up to 21 weeks after procedure ]Binary variable describing the presence of a uterine dehiscence, regardless of whether it is symptomatic or it is diagnosed at the time of cesarean section
- Acute Pulmonary edema (yes/no) [ Time Frame: Between the procedure and birth, up to 21 weeks after procedure ]Binary variable describing the presence of a maternal pulmonary edema, regardless of the severity, between the procedure and discharge.
- Closure of the spinal defect (yes/no) [ Time Frame: Between birth and 1 month of life ]Binary variable describing the watertight closure of the defect
- Maintenance of the neurological level (Better / same / worse) [ Time Frame: 1 month of life ]Categorical variable describing if the postnatally assessed neurological level is better / same or worse than the level assessed prenatally before the procedure. It will be assessed by physical examination
- Reversal of Chiari malformation(completely reversed / mild improvement / no improvement) by MRI [ Time Frame: 1 month of life ]Categorical variable comparing the postnatal and prenatal MRI assessment of the Chiari malformation
- Ventriculoperitoneal shunting (yes/no) [ Time Frame: Between birth and 12 months ]Binary variable describing the need of a ventriculoperitoneal shunting
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03315637
|Hospital Universitari Vall d'Hebron||Recruiting|
|Barcelona, Spain, 08035|
|Contact: Elena Carreras, PhD firstname.lastname@example.org|
|Contact: Nerea Maiz, PhD email@example.com|