Miyabe Marcos M, Murphy Kendall P, Oria Marc, Duru Soner, Lin Chia-Ying, Peiro Jose L
Center for Fetal and Placental Research, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, USA.
Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
Childs Nerv Syst. 2022 May;38(5):873-891. doi: 10.1007/s00381-022-05486-8. Epub 2022 Apr 4.
The use of materials to facilitate dural closure during spina bifida (SB) repair has been a highly studied aspect of the surgical procedure. The overall objective of this review is to present key findings pertaining to the success of the materials used in clinical and pre-clinical studies. Additionally, this review aims to aid fetal surgeons as they prepare for open or fetoscopic prenatal SB repairs.
Relevant publications centered on dural substitutes used during SB repair were identified. Important information from each article was extracted including year of publication, material class and sub-class, animal model used in pre-clinical studies, whether the repair was conducted pre-or postnatally, the bioactive agent delivered, and key findings from the study.
Out of 1,121 publications, 71 were selected for full review. We identified the investigation of 33 different patches where 20 and 63 publications studied synthetic and natural materials, respectively. From this library, 43.6% focused on clinical results, 36.6% focused on pre-clinical results, and 19.8% focused on tissue engineering approaches. Overall, the use of patches, irrespective of material, have shown to successfully protect the spinal cord and most have shown promising survival and neurological outcomes.
While most have shown significant promise as a therapeutic strategy in both clinical and pre-clinical studies, none of the patches developed so far are deemed perfect for SB repair. Therefore, there is an opportunity to develop new materials and strategies that aim to overcome these challenges and further improve the outcomes of SB patients.
在脊柱裂（SB）修复过程中使用材料促进硬脑膜闭合一直是该手术中研究较多的一个方面。本综述的总体目标是呈现临床和临床前研究中所用材料成功应用的关键发现。此外，本综述旨在帮助胎儿外科医生为开放性或胎儿镜下产前SB修复手术做准备。
确定了以SB修复过程中使用的硬脑膜替代物为中心的相关出版物。提取了每篇文章的重要信息，包括发表年份、材料类别和亚类、临床前研究中使用的动物模型、修复是在产前还是产后进行、所递送的生物活性剂以及该研究的关键发现。
在1121篇出版物中，71篇被选作全面综述。我们确定了对33种不同补片的研究，其中20篇和63篇出版物分别研究了合成材料和天然材料。在这个文献库中，43.6%关注临床结果，36.6%关注临床前结果，19.8%关注组织工程方法。总体而言，无论使用何种材料，补片的使用都已证明能成功保护脊髓，且大多数都显示出了良好的存活和神经学结果。
虽然大多数在临床和临床前研究中都显示出了作为一种治疗策略的巨大潜力，但迄今为止开发的补片都未被认为是完美适用于SB修复的。因此，有机会开发旨在克服这些挑战并进一步改善SB患者治疗结果的新材料和策略。
