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44Th Annual Meeting of International Society for Pediatric Neurosurgery, Kobe, Japan, Oct 23-27, 2016

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44Th Annual Meeting of International Society for Pediatric Neurosurgery, Kobe, Japan, Oct 23-27, 2016 Childs Nerv Syst (2016) 32:1957––2040 DOI 10.1007/s00381-016-3209-9 ABSTRACTS 44th Annual Meeting of International Society for Pediatric Neurosurgery, Kobe, Japan, Oct 23-27, 2016 This supplement was not sponsored by outside commercial interests. It was funded entirely by the publisher. Graciela Zuccaro, ISPN President scan were compatible with zvae. Both mothers reported symptoms of ZV Mami Yamasaki, ISPN 2016 Annual Meeting Chair fever in the first months of pregnancy. Assesment and follow up by the Graham Fieggen, ISPN 2016 Scientific Committee Chair neurorehabilitation team demonstrated severe neurologial disability with up- Tony Figaji, ISPN 2016 Scientific Committee Co-Chair per motor neuron syndrome. CONCLUSIONS:Zvae is a threatening and rapidly spreading outbreak with high potential for mortality and morbidity. The pediatic neurosurgeon must PLATFORM PRESENTATIONS take part in the management task force helping to establish differential diag- nosis and to rapidly separate true cases from those related to neurosurgical Monday, 24 October 2016 diseases. 09:00 – 09:32 Keywords: Zika virus, encephalitis, microcephaly, hidrocephalus. Platform presentations 1: Fetal Diagnosis and Management PF-002 Special topic: Fetal diagnosis and management PF-001 Special topic: Fetal diagnosis and management First 50 fetal in-utero microsurgical myelomeningocele repairs: critical comparison of neurosurgical and maternal outcomes to the MOMS trial Zika virus fetal encephalitis outbreak: what is the role of the pediatric neurosurgeon in the response strategy? Samer K Elbabaa1, Theresa M Williard1, Emanuel J Vlastos2 1Division of Pediatric Neurosurgery, Department of Neurosurgery, Saint Louis Carlos Eduardo Jucá1, André Luiz Pessoa3, Erlane Ribeiro2,Rafaela University School of Medicine, Saint Louis, United States Menezes4, Thayse Lopes4, Vivian Mota1, Renata Jucá5 2Saint 7Louis Fetal Care Institute, SSM Cardinal Glennon Children's Hospital, 1Universidade de Fortaleza, Fortaleza, Brazil Saint Louis, United States 2Hospital Infantil Albert Sabin, Fortaleza, Brazil 3Instituto Hippocampus, Fortaleza, Brazil OBJECTIVE:The Management of Myelomeningocele Study (MOMS) trial re- 4Centro Universitário Christus - Unichristus, Fortaleza, Brazil sults showed improved hydrocephalus and motor outcomes in prenatal repair 5Universidade Federal do Ceará (UFC), Fortaleza, Brazil group compared to the postnatal group. We report our initial 50 case series of fetal in-utero myelomeningocele (MMC) repair experience and outcomes at the Saint OBJECTIVE:Zika virus (ZV) fetal encephalitis is an emergent disease provoking Louis Fetal Care Institute. The learning curve was also observed and assessed. an outbreak in Brazil. It is considered a global emergency by the World Health MATERIAL-METHODS:We strictly followed the maternal/fetal inclusion and Organization. Aim of this study is discuss the role of the pediatric neurosurgeon in exclusion criteria used by the MOMS trial.A multidisciplinary fetal MMC repair the response strategy of this new threatening neurological disease. team performed 50 repairs between May 2011 and March 2016.We prospectively MATERIAL-METHODS:Report of epidemiological, clinical and radiological followed maternal, fetal and neonatal data.The data was compiled to evaluate the features of ZV encephalitis outbreak in Brazil. Report of illustrative cases learning curve to meet the MOMS results held as standard of care. imposing differential diagnosis with pediatric neurosurgical diseases. RESULTS:All MMC defects underwent successful in-utero repair.Average Establishment of the place of the neurosurgeon in the outbreak task force. GA at time of MMC repair was 24+3/7 weeks.Average GA at time of delivery RESULTS:From october 2015 to march 2016, 6776 suspected cases of zika was 34+4/7 weeks,with 50% of pregnancies reached 37 weeks.Operative time virus associated encephalitis (zvae) were notified, 944 confirmed and the of microsurgical MMC repair after hysterotomy averaged 43 minutes.Two others under investigation, with 208 perinatal deaths. Clinical presentation perinatal mortalities 2/50(4%) were due to complications of prematurity.CSF is linked to severe microcephaly. Computer tomography (CT) show brain diversion rate of all surviving children via VP shunt or ETV was 20/ atrophy and spread calcifications. Association of zika infection and micro- 48(41.6%),MOMS trial was 40%.ETV success rate was 8/17(47%) with an cephaly was confirmed by polymerase chain reaction in 130 cases. Our average follow up 20 months.When statistically compared to MOMS pediatric neurosurgery unit received two cases mimicking neurosurgical dis- trial,maternal outcomes were either equivalent or improved for all categories eases. Case 1: a 28 years old pregnant woman at the 26th week was referred except pulmonary edema,chorioamnionitis and preterm labor.Fetal outcomes due to fetal ultrasound suggesting hydrocephalus. Magnetic resonance were also improved or equivalent.Surgical skin to skin time significantly in- showed ventricular enlargement as result of brain atrophy. At birth, HC creased from the first 10 cases to the next 37 cases(p<.001) which then led to was 31cm, morphology and CT presented the features of zvae. Case 2: A significantly increase in days between repair and delivery(p <0.05) and in- 22 days old male newborn was referred due to suspicion of craniostenosis. crease in infant birth weight(p<0.05).Ten cases appear to be the threshold for The anterior fontanell was closed. HC was 30cm. Clinical aspect and CT our center to consistency in equivalent results. 1958 Childs Nerv Syst (2016) 32:1957–2040 CONCLUSIONS:Fetal,maternal and neurosurgical outcome equivalency was hydrocephalus in a communicating or non-obstructive hydrocephalus with shown between Saint Louis series and the MOMS trial. Ten cases appear to be decreasing degrees of Chiari type 2 and improves the motor level of these the point at which this equivalency is reached. ETV deserves a closer look and patients. A learning curve is critical in reducing fetal mortality and a trained may show promising results in the setting of improved hindbrain herniation. multidisciplinary team is important for obtaining good results. Keywords: fetal in-utero surgery, myelomeningocele, spina bifida, MOMS Keywords: fetal myelomeningocele, intrauterine repair, open surgery, hydro- trial cephalus, Chiari 2, fetal surgery PF-003 PF-004 Special topic: Fetal diagnosis and management Special topic: Fetal diagnosis and management Lessons learned after 180 fetal surgeries for myelomeningocele First year neurologic outcome after fetal surgery 1 1 2 Sergio Cavalheiro1, Antonio Fernandes Moron2, Italo Capraro Suriano1, Ibrahim Alatas , Huseyin Canaz ,KeremOzel 1 Mauricio Barbosa2, Hebener Milani2, Patricia Alessandra Dastoli1, Jardel Department of Neurosurgery, Florence Nightingale Hospital, Istanbul Bilim Mendonça Nicacio1, Stefano Sarmento2, Marcos Devanir Costa1, Tatiana University, Istanbul, Turkey 2 Sibovi1, Lorena Pavon1 Department of Pediatric Surgery, Florence Nightingale Hospital, Istanbul 1Sergio Cavalheiro: Neurosurgery Department, Federal University of Sao Bilim University, Istanbul, Turkey Paulo, Santa Joana Hospital, Sao Paulo, Brazil 2Antonio Fernandes Moron: Fetal Medicine Department Federal University of OBJECTIVE:Since the results of the Management of Myelomeningocele Sao Paulo, Santa Joana Hospital, Brazil Study were published, maternal-fetal surgery for the in utero treatment of spina 3Italo Capraro Suriano: Neurosurgery Department, Federal University of Sao biifda has become accepted as a standard of care alternative. There are two Paulo, Santa Joana Hospital, Sao Paulo, Brazil kinds of approach for intrauterine myelomeningocele repair, which are 4Mauricio Barbosa: Fetal Medicine Department Federal University of Sao fetoscopic approach and open surgery. Our aim is to present first year neuro- Paulo, Santa Joana Hospital, Brazil logical evaluation and urodynamic results of four patients who were under- 5Hebener Milani: Fetal Medicine Department Federal University of Sao Paulo, gone percutaneous fetoscopic patch closure for myelomeningocele. Santa Joana Hospital, Brazil MATERIAL-METHODS:Four patients were evaluated according to neuro- 6Patricia Dastoli: Neurosurgery Department, Federal University of Sao Paulo, logical examination, severity of hydrocephalus, urodynamic study results Santa Joana Hospital, Sao Paulo, Brazil and MRI findings at the end of their first year of life. 7Jardel Nicacio: Neurosurgery Department, Federal University of Sao Paulo, RESULTS:There was no need for shunting in any of four patients. Over active Santa Joana Hospital, Sao Paulo, Brazil detrussor and detrussor sphincter dyssynergia were occured in all patients but 8Stefano Sarmento: Fetal Medicine Department Federal University of Sao clean transsient catheterization was needed in only one patient according to Paulo, Santa Joana Hospital, Brazil urodynamic study parameters. In one patient, clonus was occured in the sixth 9Marcos Devanir Costa: Neurosurgery Department, Federal University of Sao month of life and tethered cord releasing operation was performed. Paulo, Santa Joana Hospital, Sao Paulo, Brazil CONCLUSIONS:Fetal surgery is associated with spinal segmental neuropro- 10Tatiana Sibove: Neurosurgery Department, Federal University of Sao Paulo, tection and decrease of Chiari malformation and shunt depended hydroceph- Santa Joana Hospital, Sao Paulo, Brazil alus. Further research is needed to better understand the pathophysiology
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