In Utero Restoration of Hindbrain Herniation in Fetal Myelomeningocele as Part of Prenatal Regenerative Therapy Program at Mayo Clinic

Rodrigo Ruano, David J. Daniels, Edward S. Ahn, Eniola R. Ibirogba, Victor M. Lu, Kendall A. Snyder, Mari Charisse Trinidad, William A. Carey, Christopher E. Colby, Amy B. Kolbe, Katherine W. Arendt, Leal Segura, Hans P. Sviggum, M. Yasir Qureshi, Abimbola Famuyide, Andre Terzic

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Objective: To assess our initial experience with prenatal restoration of hindbrain herniation following in utero repair of myelomeningocele (MMC). Patients and Methods: Three consecutive patients with prenatally diagnosed MMC (between January 1, 2018 and September 30, 2018) were managed with open in utero surgery. As per institutional review board approval and following a protocol designed at the Mayo Clinic Maternal & Fetal Center, fetal intervention was offered between 19 0/7 and 25 6/7 weeks of gestation. Prenatal improvement of hindbrain herniation was the declared restorative end point. Obstetrical and perinatal outcomes were also assessed. Results: Diagnosis of MMC was confirmed upon referral between 20 and 21 weeks’ gestation by using fetal ultrasound and magnetic resonance imaging. In all cases reported here, the spinal defect was lumbosacral with evidence of hindbrain herniation. Open in utero MMC repair was performed between 24 and 25 weeks’ gestation with no notable perioperative complications. Postprocedure fetal magnetic resonance imaging performed 6 weeks after in utero repair documented improvement of hindbrain herniation. Deliveries were at 37 weeks by cesarean section without complications. Most recent postnatal follow-ups were unremarkable at both 11 months (baby 1) and 3 months of age (baby 2), with mild ventriculomegaly. Antenatal and postnatal follow-up of baby 3 at 1 month of age was also unremarkable. Conclusion: Our study highlights the prenatal restoration of hindbrain herniation following in utero MMC repair in all cases presented here as an example of a prenatal regenerative therapy program in our institution.

Original languageEnglish (US)
Pages (from-to)738-746
Number of pages9
JournalMayo Clinic proceedings
Volume95
Issue number4
DOIs
StatePublished - Apr 2020

ASJC Scopus subject areas

  • Medicine(all)

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    Ruano, R., Daniels, D. J., Ahn, E. S., Ibirogba, E. R., Lu, V. M., Snyder, K. A., Trinidad, M. C., Carey, W. A., Colby, C. E., Kolbe, A. B., Arendt, K. W., Segura, L., Sviggum, H. P., Qureshi, M. Y., Famuyide, A., & Terzic, A. (2020). In Utero Restoration of Hindbrain Herniation in Fetal Myelomeningocele as Part of Prenatal Regenerative Therapy Program at Mayo Clinic. Mayo Clinic proceedings, 95(4), 738-746. https://doi.org/10.1016/j.mayocp.2019.10.039