Virtual navigation for the improvement of parents counseling and the planning of fetal endoscopic myelomeningocele repai
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TECHNICAL NOTE
Virtual navigation for the improvement of parents counseling and the planning of fetal endoscopic myelomeningocele repair Heron Werner 1 & Gerson Ribeiro 1,2 & Jorge Lopes 2 & Renato Augusto Moreira Sá 3 & Fernando Maia 4 & Pedro Castro 1 & Edward Araujo Júnior 5 Received: 7 October 2020 / Accepted: 30 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Myelomeningocele (MMC) is the most severe form of spina bifida with intrauterine repairs becoming more prevalent. The development of three-dimensional ultrasound (3DUS) and magnetic resonance imaging (MRI) has drastically improved the visualization of fetal anatomy. Methods: Virtual Navigation (VN) results from a technology that uses software generated realistic images to replicate the immersive feeling of a real environment. Conclusion This report aims to demonstrate VN in a Chiari II malformation case, obtained from 3DUS and MRI files, comparing this with the fetal endoscopic surgery for MMC. Keywords Myelomeningocele . Fetal surgery . Three-dimensional ultrasound . Magnetic resonance imaging . Virtual navigation
Introduction Myelomeningocele (MMC) is the most severe form of spina bifida and is characterized by a protrusion of the spinal cord and the meninges through a defect in the vertebral column. This disease presents as an accomplished motor and sensory neurological deficit below the lesion level. Urinary and fecal incontinence frequently occur, including hindbrain herniation
Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s00381-02004961-4. * Edward Araujo Júnior [email protected] 1
Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
2
Department of Arts and Design, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, RJ, Brazil
3
Department of Obstetrics, Fluminense Federal University (UFF), Niterói, RJ, Brazil
4
Fetal Medicine Unit, Fernandes Figueira Institut, Rio de Janeiro, RJ, Brazil
5
Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, Brazil
(Chiari II malformation) and associated hydrocephalus, which often require shunting. Orthopedic abnormalities, including talipes (club foot), contractures, hip dislocation, scoliosis, and kyphosis, are frequently observed [1]. In 2011, a randomized controlled trial, titled the “Management of Myelomeningocele Study,” demonstrated the effectiveness of open intrauterine surgery with lower shunt placement rates and improvements in mental development and motor function compared with postnatal surgery. However, prenatal surgery was associated with an increased risk of preterm delivery and uterine dehiscence at delivery [2]. Fetoscopic MMC surgery is a minimally invasive technique that decreases the obstetrical complications associated with open surgery, mainly uterine dehiscence. However, it is associated wit
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