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Peiro, Jose L.; Duru, Soner; Fernandez-Tome, Blanca; Peiro, Lucas; Encinas, Jose L.; Sanchez-Margallo, Francisco M.; Oria, Marc
{ "DOI": "10.1227/neu.0000000000002361", "abstract": "<p>BACKGROUND:Congenital obstructive hydrocephalus generates progressive irreversible fetal brain damage by ventricular enlargement and incremental brain tissue compression that leads to maldevelopment and poor clinical outcomes. Intrauterine treatments such as ventriculo-amniotic shunting have been unsuccessfully tried in the eighties.OBJECTIVE:To assess if prenatal endoscopic third ventriculostomy (ETV) is feasible in a large animal model and optimize this technique for ventricular decompression and potential arrest of fetal brain damage in fetal lambs.METHODS:We generated hydrocephalus in 50 fetal lambs by injecting a polymeric agent into the cisterna magna at midgestation (E85). Subsequently, 3 weeks later (E105), fetal ETV was performed using a small rigid fetoscope. The endoscopy entry point was located anterior to the coronal suture, 7 mm from the midline.RESULTS:We obtained clear visualization of the enlarged lateral ventricles by endoscopy in the hydrocephalic fetal lambs. The floor of the third ventricle was bluntly perforated and passed with the scope for a successful ETV. Total success was achieved in 32/50 cases (64%). Causes of failure were blurred vision or third ventricle obliteration by BioGlue in 10/50 (20%) cases, anatomic misdirection of the endoscope in 5 (10%) cases, 2 cases of very narrow foramen of Monro, and 1 case of choroid plexus bleeding. If we exclude the cases artificially blocked by the polymer, we had a successful performance of prenatal-ETV in 80% (32/40) of hydrocephalic fetuses.CONCLUSION:Despite the inherent difficulties arising from ovine brain anatomy, this study shows that innovative fetal ETV is technically feasible in hydrocephalic fetal lambs.</p>", "author": [ { "family": "Peiro", "given": " Jose L." }, { "family": "Duru", "given": " Soner" }, { "family": "Fernandez-Tome", "given": " Blanca" }, { "family": "Peiro", "given": " Lucas" }, { "family": "Encinas", "given": " Jose L." }, { "family": "Sanchez-Margallo", "given": " Francisco M." }, { "family": "Oria", "given": " Marc" } ], "container_title": "NEUROSURGERY", "id": "265704", "issue": "6", "issued": { "date-parts": [ [ 2023, 1, 1 ] ] }, "page": "9", "title": "Fetal Endoscopic Third Ventriculostomy Is Technically Feasible in Prenatally Induced Hydrocephalus Ovine Model", "type": "article-journal", "volume": "92" }
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