Publikationen

In utero Hepatitis B Immunization during Fetal Surgery for Spina Bifida

Ueli Moehrlen 1 2 3, Julia Elrod 1 3, Nicole Ochsenbein-Kölble 2 4, Christoph Berger 3 5, Roberto F Speck 6, Luca Mazzone 1 2 3, Franziska Krähenmann 2 4, Roland Zimmermann 2 4, Martin Meuli 7 8 9

Fetal surgery for spina bifida aperta may lead to significantly better outcomes than postnatal repair, particularly regarding shunt-dependent hydrocephalus, independent ambulation, and voiding functions. The "Management of Myelomeningocele Study" (MOMS) represents the current benchmark, also in terms of eligibility criteria.

Journal: Karger Fetal Diagnosis and Therapy - published online: November 13, 2019

Date: 01/04/2020

1. Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
2. The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland.
3. Children's Research Center (CRC), University Children's Hospital Zurich, Zurich, Switzerland.
4. Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.
5. Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland.
6. Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
7. Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland, martin.meuli@kispi.uzh.ch.
8. The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland, martin.meuli@kispi.uzh.ch.
9. Children's Research Center (CRC), University Children's Hospital Zurich, Zurich, Switzerland, martin.meuli@kispi.uzh.ch.

Benchmarking against the MOMS Trial: Zurich Results of Open Fetal Surgery for Spina Bifida

Ueli Moehrlen 1 2 3, Nicole Ochsenbein-Kölble 2 4, Luca Mazzone 1 2 3, Franziska Kraehenmann 2 4, Margaret Hüsler 2 4, Barbara Casanova 1 2 3, Peter Biro 1 5, David Wille 6 3, Bea Latal 7 3, Ianina Scheer 2 8 3, Vera Bernet 9 3, Theres Moehrlen 1 2 3, Leonhard Held 10, Alan W Flake 11, Roland Zimmermann 2 4, Martin Meuli 12 13 14

The Management of Myelomeningocele Study, a.k.a. the MOMS trial, was published in 2011 in the New England Journal of Medicine. This prospective randomized controlled trial proved to be a milestone publication that provided definitive evidence that fetal surgery is a novel standard of care for select fetuses with spina bifida aperta (SB). The goal of our study is to assess whether our center can match these benchmark results.

Journal: Karger Fetal Diagnosis and Therapie - published online: June 5, 2019

Date: 01/02/2020

1Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.

2The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.

3Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland.

4Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.

5Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland.

6Department of Pediatric Neurology, University Children's Hospital Zurich, Zurich, Switzerland.

7Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.

8Department of Diagnostic Imaging, MR-Center, University Children's Hospital Zurich, Zurich, Switzerland.

9Department of Intensive Care and Neonatology, University Children's Hospital Zurich, Zurich, Switzerland.

10Department of Biostatistics, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland.

11The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

12Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland

13The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland

14Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland

Bioengineering and in utero transplantation of fetal skin in the sheep model: A crucial step towards clinical application in human fetal spina bifida repair

Luca Mazzone 1, 2, 3, 4, Ueli Moehrlen 1, 2, 4, Nicole Ochsenbein-Kölble 2, 5, Luca Pontiggia 3, 4, Thomas Biedermann 3, 4, Ernst Reichmann 3, 4, Martin Meuli 1, 2, 3, 4

An intricate problem during open human fetal surgery for spina bifida regards back skin closure, particularly in those cases where the skin defect is much too large for primary closure. We hypothesize that tissue engineering of fetal skin might provide an adequate autologous skin substitute for in utero application in such situations. Eight sheep fetuses of four time-mated ewes underwent fetoscopic skin biopsy at 65 days of gestation. Fibroblasts and keratinocytes isolated from the biopsy were used to create fetal dermo-epidermal skin substitutes. These were transplanted on the fetuses by open fetal surgery at 90 days of gestation on skin defects (excisional wounds) created during the same procedure. Pregnancy was allowed to continue until euthanasia at 120 days of gestation. The graft area was analyzed macroscopically and microscopically. The transplanted fetal dermo-epidermal skin substitutes was well discernable in situ in three of the four fetuses available for analysis. Histology confirmed healed grafts with a close to natural histological skin architecture four weeks after in utero transplantation. This experimental study generates evidence that laboratory grown autologous fetal skin analogues can successfully be transplanted in utero. These results have clinical implications as an analogous procedure might be applied in human fetuses undergoing prenatal repair to facilitate primary skin closure. Finally, this study may also fertilize the field of fetal tissue engineering in general, particularly when more interventional, minimally invasive, and open fetal surgical procedures become available.

Journal: Journal of tissue engineering and regenerative medicine - published online: November 29, 2019

Date: 01/01/2020

1 Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.

2 Zurich Center for Fetal Diagnosis and Treatment, Zurich, Switzerland.

3 Tissue Biology Research Unit, Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.

4 Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.

5 Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.

Risk Factors for Preterm Birth following Open Fetal Myelomeningocele Repair: Results from a Prospective Cohort

Maike Katja Kahr 1 2, Franziska Winder 3 4, Ladina Vonzun 3 4, Martin Meuli 5 4, Luca Mazzone 5 4, Ueli Moehrlen 5 4, Franziska Krähenmann 3 4, Margaret Hüsler 3 4, Roland Zimmermann 3 4, Nicole Ochsenbein-Kölble 3 4

etal myelomeningocele (fMMC) repair is a therapeutic option in selected cases. This study aimed to identify risk factors for preterm birth (PTB) following open fMMC repair.

Journal: Karger Fetal Diagnosis and Therapie - published online: May 17, 2019

Date: 01/01/2020

1Division of Obstetrics, University Hospital of Zürich, Zurich, Switzerland, maikekatja.kahr@usz.ch.

2Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland, maikekatja.kahr@usz.ch.

3Division of Obstetrics, University Hospital of Zürich, Zurich, Switzerland.

4Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland.

5Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.

Inclusion Cysts after Fetal Spina Bifida Repair: A Third Hit?

Pascal Heye 1 2, Ueli Moehrlen 3 4 5 6, Luca Mazzone 3 4 5 6, Robert Weil 3 4 7, Stefan Altermatt 3 4 7, David-Alexander Wille 4 8, Ianina Scheer 4 9, Martin Meuli 3 4 5 6, Maya Horst 3 4 10

Fetal spina bifida repair (fSBR) has proven effective in the reversibility of hindbrain herniation, lower rate of shunt-dependent hydrocephalus, and independent ambulation. Besides distinct advantages, there are also concerns related to fSBR. One of these is the postnatal occurrence of inclusion cysts (IC).

Journal: Karger Fetal Diagnosis and Therapie - published online September 10, 2018

Date: 01/07/2019

1Department of Pediatric Surgery, University Children's Hospital Zurich, Zürich, Switzerland, pascalheye@gmail.com.

2Children's Research Center, University Children's Hospital Zurich, Zürich, Switzerland, pascalheye@gmail.com.

3Department of Pediatric Surgery, University Children's Hospital Zurich, Zürich, Switzerland.

4Children's Research Center, University Children's Hospital Zurich, Zürich, Switzerland.

5Division of Fetal Surgery, University Children's Hospital Zurich, Zürich, Switzerland.

6The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zürich, Switzerland.

7Division of Pediatric Neurosurgery, University Children's Hospital Zurich, Zürich, Switzerland.

8Division of Pediatric Neurology, University Children's Hospital Zurich, Zürich, Switzerland.

9Division of Diagnostic Imaging, University Children's Hospital Zurich, Zürich, Switzerland.

10Division of Pediatric Urology, University Children's Hospital Zurich, Zürich, Switzerland.