Comparison of two surgical techniques for the intrauterine repair of meningomyelocele in sheep

• Grant number: 10/00088-7
• Support Opportunities: Regular Research Grants
• Start date: November 01, 2010
• End date: October 31, 2012
• Field of knowledge: Health Sciences - Medicine - Maternal and Child Health
• Principal Investigator: Denise Araujo Lapa Pedreira
• Grantee: Denise Araujo Lapa Pedreira
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

Meningomyelocele has neurological, devastating consequences of the fetus. The surgical therapy after the fetus is born is considered palliative. The defect's correction before birth seems to improve neurological outcome. The defect's correction in human fetus has been carried out for about 9 years, using the same neurosurgical technique used after birth. The major correction complication is the thetered spinal cord associated with inclusion cysts. This finding has been more frequent in fetus corrected in utero, when compared to those corrected after birth. We believe that the actual used surgical technique could be the reason for that difference. Our group developed a less aggressive surgical technique, and comparing both techniques can demonstrate the necessity of changing the current one. Purpose: To compare two surgical techniques for the prenatal repair of meningomyelocele. Methods: In 8 pregnant sheep, a meningomyelocele-like defect will be created in the lumbar region at the 90o day gestation. In 4 cases the defect will be corrected using the classic neurosurgical technique and in 4 etus the new technique developed by the authors (FAPESP 2000/02913-3; Pedreira et al., 2002) (Fapesp 2003/07237-4; Pedreira et al., 2007) will be used. The pathological aspects of this correction will be studied on 133o day gestation (nearly the end of gestation) after the fetus sacrifice. The adherence among the surgical plans and the wound healing inflammatory response will be used to compare the groups. (AU)