M. M. Barbosa

Fetal brain tumors: Prenatal diagnosis by ultrasound and magnetic resonance imaging.

Congenital central nervous system tumors diagnosed during pregnancy are rare, and often have a poor prognosis. The most frequent type is the teratoma. Use of ultrasound and magnetic resonance image allows the suspicion of brain tumors during pregnancy. However, the definitive diagnosis is only confirmed after birth by histology. The purpose of this mini-review article is to describe the general clinical aspects of intracranial tumors and describe the main fetal brain tumors.

Antenatal management of fetal neurosurgical diseases

The advance in the imaging tools during the pregnancy (ultrasound and magnetic resonance) allowed the early diagnose of many fetal diseases, including the neurological conditions. This progress brought the neurosurgeons the possibility to propose treatments even before birth. Myelomeningocele is the most recognized disease that can be treated during pregnancy with a high rate of success. Additionally, this field can be extended to other conditions such as hydrocephalus and encephaloceles. However, each one of these diseases has nuances in the diagnostic evaluation that should fit the requirements to perform the fetal procedure and overbalance the benefits to the patients. In this article, the authors aim to review the neurosurgical aspects of the antenatal management of neurosurgical conditions based on the experience of a pediatric neurosurgery center.

Histological evidence of reparative activity in chorioamniotic membrane following open fetal surgery for myelomeningocele

An increased understanding of the reparative process in fetal membrane following surgical techniques may be helpful to decrease the risks to mother and fetus and avoid adverse pregnancy outcomes. The present study discusses histological evaluation of the fetal membrane following open fetal surgery. Chorioamniotic membranes (n=10) were obtained following birth from pregnancies that underwent open fetal surgery for myelomeningocele. The collagen distribution was quantified using picrosirius-polarization method comparing the suture site with non-suture site. The differences between the collagen fiber percentages at the two sites was evaluated by the paired t-test with P<0.05. The mean gestational age of fetal surgery was 26.09±0.3 and 33.81±0.82 weeks at birth. The picrosirius red sign was more intense at the suture site, primarily associated with collagen type 1. Collagen observed in the surgical area was significantly increased (13.22±2.84%) compared with the non-surgical area (6.16±1.09%; P<0.0001). It was observed that the reparative activity at the suture site of the fetal membrane was characterized by a significant increase in collagen fibers. The findings suggest nascent collagen synthesis, tissue remodeling and repair of suture site, a mechanism likely to prevent the amniotic fluid leakage and maintain pregnancy following open fetal surgery.

Prediction of acidemia at birth by Doppler assessment of fetal cerebral transverse sinus in pregnancies with placental insufficiency.

To evaluate the prediction of acidemia at birth using cerebral transverse sinus (CTS) Doppler velocimetry and to determine the best parameter and cut‐off values for its prediction in pregnancies complicated with placental insufficiency.

P02.32: Spinal muscular atrophy and increased nuchal translucency—case report

congenital contractural syndrome type 2 (LCCS2) (OMIM 607598) which is also associated with renal and cardiac malformations. A genome-wide linkage analysis, demonstrating linkage to approximately 6 cM homozygosity region on chromosome 12q13 between markers D12S1604 and D12S83, was found. Therefore, early genetic detection of this syndrome is possible. However, many patients known to be carriers of this genes deny an invasive procedure and in others this genetic diagnosis is not found. Thus, sonographic detection may be the sole tool for early detection of this abnormality. The sonographic appearance of LCCS2 in our area may appear late in second trimester and early sonographic diagnosis may be important in counseling these patients, Lately, we have sonographically diagnosed 3 patients in the fetal malformation clinic at 13–14 weeks gestation. The main sonographic symptom was myoclonic jerks of hands and feet of these fetuses. Hands were flexed in the elbow joints and the jerks were from the shoulder girdle. Jerks were from the hip joint. At that time no joint contractures were apparent. These appeared only at 17 weeks gestation. In summary, tonic myoclonic jerks are demonstrated sonographically and can be an early neurologic sign for hypokynesia/akinesia syndrome. Future sonographic observations in first trimester should be offerred to high risk patients prone to neurological accidents and congenital malformations.

Perinatal outcomes after open fetal surgery for myelomeningocele repair: a retrospective cohort study

Describe outcomes of open fetal surgery for myelomeningocele (MMC) repair in two Brazilian hospitals and the impact of surgical experience on outcome.

Ductus venosus versus cerebral transverse sinus Doppler velocimetry for predicting acidemia at birth in pregnancies complicated by placental insufficiency.

The objectives of this study is to compare ductus venosus (DV) and cerebral transverse sinus (CTS) Doppler velocimetry for predicting acidemia at birth in pregnancies complicated by placental insufficiency.

The assessment of fetal well-being by venous Doppler velocimetry

The assessment of fetal well-being by venous Doppler velocimetry, especially in cases of intrauterine growth restriction, has been growing in importance as a number of researchers have been improving their studies 1  -  5 as well as a consequence of better technologies in ultrasound equipment. Since different authors have studied the fetal blood circulation with color Doppler, initially focusing their attention on the arterial system 6  -  12

Cerebellar herniation demonstrated by the occipitum‐dens line: Ultrasonography assessment of normal fetuses, fetuses with myelomeningocele, and fetuses that underwent antenatal myelomeningocele surgery

To establish a method to quantify the position of the cerebellum by ultrasonography in normal fetuses, fetuses with myelomeningocele (MMC), and fetuses that underwent in utero MMC repair.

Fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome treatment: initial experience in tertiary reference center in Brazil

Objective To evaluate the initial maternal and perinatal outcomes of fetoscopic laser photocoagulation for the treatment of twin-to-twin transfusion syndrome (TTTS) in a referral center in Brazil. Methods This prospective observational study analyzed 24 fetoscopic laser photocoagulation procedures at 18–26 weeks of gestation. TTTS severity was determined using the Quintero classification. Blood vessels that crossed the interamniotic membrane were nonselectively photocoagulated. The χ2 test and Mann-Whitney U test were used for the statistical analysis. Results The mean (±standard deviation) age of pregnant women, gestational age at surgery, surgical time, gestational age at birth, and newborn weight were 32.2±4.1 years, 20.7±2.9 weeks, 51.8±16.7 minutes, 30.5±4.1 weeks, and 1,531.0±773.1 g, respectively. Using the Quintero classification, there was a higher percentage of cases in stage III (54.2%), followed by stages IV (20.8%), II (16.7%), and I (8.3%). Ten (41.7%) donor fetuses died and 14 (58.3%) donor fetuses survived until the end of gestation. Placental insertion location (anterior vs. posterior) did not affect the incidence of iatrogenic septostomy, surface bleeding, and premature rupture of membranes until the end of gestation. The death rate of donor and recipient fetuses before 24th gestational week increased with severity of TTTS. Conclusion The maternal and perinatal outcomes resulting from the implementation of a new minimally invasive surgical technique are in line with those obtained in major centers worldwide, considering the learning curves and infrastructures.