PMID- 36964735
OWN - NLM
STAT- MEDLINE
DCOM- 20231025
LR  - 20231027
IS  - 1933-0693 (Electronic)
IS  - 0022-3085 (Linking)
VI  - 139
IP  - 4
DP  - 2023 Oct 1
TI  - Cryopreserved human umbilical cord as a meningeal patch during in utero spina 
      bifida repair in a modified ovine model.
PG  - 1169-1179
LID - 10.3171/2023.2.JNS222928 [doi]
AB  - OBJECTIVE: Despite in utero spina bifida (SB) repair, more than two-thirds of 
      patients with SB are unable to ambulate independently, and 1 in 4 children need 
      surgery for tethered cord by school age. The objective of this study was to test 
      the cryopreserved human umbilical cord (HUC) as an antiscarring material to 
      reduce tethering and improve function in a modified in utero SB repair model. 
      METHODS: An SB defect (L2-6 levels) without myelotomy was created in fetuses of 
      timed-pregnant ewes at gestational day (GD) 75. On GD 96, the fetal defect was 
      exposed, and the arachnoid layer was removed to disrupt the barrier and expose 
      the spinal cord to simulate human in utero SB repair. The fetuses were randomly 
      assigned to two groups according to the method used to cover the spinal cord: the 
      conventional repair (CR) group, for which myofascial closure was used (n = 7), 
      and the HUC meningeal patch group, for which HUC was used as a meningeal patch (n 
      = 6), followed by primary skin closure. The lambs were delivered at GD 140. 
      Blinded clinical assessment of spinal cord function was performed using the Texas 
      Spinal Cord Injury Scale (TSCIS). Histology of the spine was performed for 
      quantitative assessment of spinal cord tethering, inflammatory markers, and 
      arachnoid layer regeneration. RESULTS: The TSCIS scores were significantly lower 
      in the CR than the HUC meningeal patch group (p = 0.0015) and the controls (p = 
      0.0018). The loss of spinal cord function in the CR group was mainly due to 
      ataxia and loss of proprioception (p = 0.01 and 0.005 vs control and HUC, 
      respectively). The histology at the repair site showed higher rates of spinal 
      cord tethering in the CR lambs than the HUC lambs at all levels of the repair 
      site (p = 0.01 and 0.02 vs control and HUC, respectively). In the CR with 
      tethering compared with the HUC repair, there was a lower arachnoid layer 
      covering at the repair site (p = 0.001). There was greater astrocyte activation 
      in the posterior column in the CR than in the HUC repair group (p = 0.01). 
      CONCLUSIONS: In a modified ovine SB model, the HUC as a meningeal patch allows 
      regeneration of the arachnoid layer, prevents spinal cord tethering, and improves 
      spinal cord function after in utero SB repair.
FAU - Mann, Lovepreet K
AU  - Mann LK
AD  - 1Department of Obstetrics, Gynecology and Reproductive Medicine, Division of 
      Fetal Intervention, UTHealth Houston, The University of Texas McGovern Medical 
      School, Houston.
AD  - 2The Fetal Center at Children's Memorial Hermann Hospital, Houston.
FAU - Won, Jong H
AU  - Won JH
AD  - 1Department of Obstetrics, Gynecology and Reproductive Medicine, Division of 
      Fetal Intervention, UTHealth Houston, The University of Texas McGovern Medical 
      School, Houston.
AD  - 2The Fetal Center at Children's Memorial Hermann Hospital, Houston.
FAU - Garnett, Jeannine
AU  - Garnett J
AD  - 1Department of Obstetrics, Gynecology and Reproductive Medicine, Division of 
      Fetal Intervention, UTHealth Houston, The University of Texas McGovern Medical 
      School, Houston.
AD  - 2The Fetal Center at Children's Memorial Hermann Hospital, Houston.
FAU - Patel, Rajan P
AU  - Patel RP
AD  - Departments of3Diagnostic and Interventional Imaging and.
FAU - Narayana, Ponnada A
AU  - Narayana PA
AD  - Departments of3Diagnostic and Interventional Imaging and.
FAU - Jain, Ranu
AU  - Jain R
AD  - 2The Fetal Center at Children's Memorial Hermann Hospital, Houston.
AD  - 4Anesthesia, UTHealth Houston, The University of Texas McGovern Medical School, 
      Houston; and.
FAU - Fletcher, Stephen A
AU  - Fletcher SA
AD  - 2The Fetal Center at Children's Memorial Hermann Hospital, Houston.
AD  - 5Department of Pediatric Surgery, Division of Pediatric Neurosurgery, UTHealth 
      Houston, The University of Texas McGovern Medical School, Houston, Texas.
FAU - Papanna, Ramesha
AU  - Papanna R
AD  - 1Department of Obstetrics, Gynecology and Reproductive Medicine, Division of 
      Fetal Intervention, UTHealth Houston, The University of Texas McGovern Medical 
      School, Houston.
AD  - 2The Fetal Center at Children's Memorial Hermann Hospital, Houston.
LA  - eng
GR  - R21 HD092754/HD/NICHD NIH HHS/United States
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
DEP - 20230324
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
SB  - IM
MH  - Animals
MH  - Child
MH  - Female
MH  - Humans
MH  - Pregnancy
MH  - Cryopreservation
MH  - Neurosurgical Procedures/methods
MH  - Sheep
MH  - Spinal Cord/surgery
MH  - *Spinal Dysraphism/surgery/pathology
MH  - Umbilical Cord/pathology
OTO - NOTNLM
OT  - antiscarring
OT  - arachnoid layer regeneration
OT  - cryopreserved human umbilical cord patch
OT  - in utero repair
OT  - spina bifida
OT  - spinal cord tethering
OT  - surgical technique
EDAT- 2023/03/26 06:00
MHDA- 2023/10/23 12:43
CRDT- 2023/03/25 07:22
PHST- 2022/12/30 00:00 [received]
PHST- 2023/02/06 00:00 [accepted]
PHST- 2023/10/23 12:43 [medline]
PHST- 2023/03/26 06:00 [pubmed]
PHST- 2023/03/25 07:22 [entrez]
AID - 10.3171/2023.2.JNS222928 [doi]
PST - epublish
SO  - J Neurosurg. 2023 Mar 24;139(4):1169-1179. doi: 10.3171/2023.2.JNS222928. Print 
      2023 Oct 1.