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In-Utero Endoscopic Correction of Spina Bifida

Primary Purpose

Neural Tube Defects, Spina Bifida, Myelomeningocele

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
In Utero Endoscopic Correction of Myelomeningocele IDE - Percutaneous Technique
In Utero Endoscopic Correction of Myelomeningocele IDE - Laparotomy/Uterine Exteriorization Technique
Sponsored by
University of Southern California
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Neural Tube Defects

Eligibility Criteria

18 Years - 52 Years (Adult)FemaleAccepts Healthy Volunteers

Inclusion Criteria:

  1. Myelomeningocele (including myeloschisis) at level T1 through S1 with hindbrain herniation. Lesion level and hindbrain herniation will be confirmed by MRI and ultrasonography.
  2. Maternal age ≥18 years.
  3. Gestational age of 19 to 27 6/7 weeks' gestation as determined by clinical information and evaluation of first ultrasound.
  4. Balanced karyotype and/or normal mircoarray with written confirmation of culture results. Results by fluorescence in situ hybridization (FISH) will be acceptable if the patient is at 24 weeks or more.
  5. Positive evaluation of social work consult indicating the patient is capable of consenting to the procedure and has the appropriate social support system to participate in the study.
  6. Positive evaluation from pediatric neurology consult.
  7. Willing to return to our center, or to a multi-disciplinary spina bifida clinic closer to their home for the 6, 12, 24, 30, 48, and 60 months follow-up evaluations.

Exclusion Criteria:

  1. Multiple gestation
  2. Insulin-dependent pregestational diabetes
  3. Presence of a fetal anomaly not related to Chiari II Malformation. A fetal echocardiogram will be conducted before surgery and if the finding is abnormal, the patient will be excluded.
  4. Fetal kyphosis of 30 degrees or more, assessed by ultrasound or MRI.
  5. Presence of uterine cervical cerclage or history of incompetent cervix.
  6. Placenta previa or placental abruption.
  7. Short cervix < 25 mm measured by cervical ultrasound.
  8. Obesity as defined by body mass index (BMI) of 40 or greater.
  9. History of previous spontaneous singleton delivery prior to 37 weeks.
  10. Maternal-fetal Rh isoimmunization, Kell sensitization or a history of neonatal alloimmune thrombocytopenia.
  11. Maternal HIV or Hepatitis-B status positive because of the increased risk of transmission to the fetus during maternal-fetal surgery. If the patient's HIV or Hepatitis B status is unknown, the patient must be tested and found to have negative results before she can be enrolled.
  12. Known Hepatitis-C positivity. If the patient's Hepatitis C status is unknown, she does not need to be screened.
  13. Uterine anomaly such as large (greater than 6 cm) fibroids, cervical fibroids or multiple fibroids or Mullerian duct abnormality.
  14. Other maternal medical condition which is a contraindication to surgery or anesthesia.
  15. Patient does not have a support person (e.g., husband, partner, parents).
  16. Inability to comply with the travel and follow-up requirements of the study.
  17. Patient does not meet psychosocial criteria as determined by the social worker evaluation.
  18. Participation in another intervention study that influences maternal and fetal morbidity and mortality.
  19. Maternal hypertension as determined by the investigator, which would increase the risk of preeclampsia or preterm delivery (including, but not limited to: uncontrolled hypertension, chronic hypertension with end organ damage and new onset hypertension in current pregnancy).
  20. Bicornuate uterus or any other uterine malformation the PI decides is not safe for surgery.
  21. Nickel allergy.
  22. Maternal request to undergo open fetal surgery for the antenatal correction of OSB at our institution primarily or after failed fetoscopic approach.
  23. Known maternal hypersensitivity to bovine collagen or chondroitin materials.

Sites / Locations

  • Hollywood Presbyterian Medical CenterRecruiting
  • Wellington Regional Medical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Percutaneous Technique

Laparotomy/Uterine Exteriorization Technique

Arm Description

The percutaneous technique uses endoscopic scopes through the maternal skin and uterus to perform the surgery. A variation of the percutaneous technique is the mini-laparotomy technique, which uses an endoscopic scope through an incision on the abdomen, smaller than a laparotomy ("mini-laparotomy"), and smaller endoscopic scopes through the maternal skin and uterus to perform the surgery.

The laparotomy/uterine exteriorization technique consists of performing a laparotomy (incision into the abdominal cavity), exteriorizing the uterus, and using endoscopic scopes through the uterus to perform the correction.

Outcomes

Primary Outcome Measures

Ability to perform the endoscopic procedure
Successful fetoscopic closure of the defect

Secondary Outcome Measures

Chiari II malformation reversal
Reversal of hindbrain herniation on ultrasound and MRI

Full Information

First Posted
March 24, 2020
Last Updated
June 12, 2023
Sponsor
University of Southern California
Collaborators
USFetus
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1. Study Identification

Unique Protocol Identification Number
NCT04362592
Brief Title
In-Utero Endoscopic Correction of Spina Bifida
Official Title
In-Utero Endoscopic Correction of Spina Bifida: Laparotomy-Assisted or Percutaneous
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Recruiting
Study Start Date
November 2, 2018 (Actual)
Primary Completion Date
June 2026 (Anticipated)
Study Completion Date
October 31, 2031 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Southern California
Collaborators
USFetus

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to evaluate the feasibility and effectiveness of performing fetoscopic surgical correction of fetal spina bifida. Two surgical approaches will be utilized: the percutaneous technique versus the laparotomy/uterine exteriorization technique.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Neural Tube Defects, Spina Bifida, Myelomeningocele

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
110 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Percutaneous Technique
Arm Type
Experimental
Arm Description
The percutaneous technique uses endoscopic scopes through the maternal skin and uterus to perform the surgery. A variation of the percutaneous technique is the mini-laparotomy technique, which uses an endoscopic scope through an incision on the abdomen, smaller than a laparotomy ("mini-laparotomy"), and smaller endoscopic scopes through the maternal skin and uterus to perform the surgery.
Arm Title
Laparotomy/Uterine Exteriorization Technique
Arm Type
Experimental
Arm Description
The laparotomy/uterine exteriorization technique consists of performing a laparotomy (incision into the abdominal cavity), exteriorizing the uterus, and using endoscopic scopes through the uterus to perform the correction.
Intervention Type
Device
Intervention Name(s)
In Utero Endoscopic Correction of Myelomeningocele IDE - Percutaneous Technique
Intervention Description
The percutaneous approach uses endoscopes through a closed maternal abdomen and closed uterus to perform the spina bifida correction.
Intervention Type
Device
Intervention Name(s)
In Utero Endoscopic Correction of Myelomeningocele IDE - Laparotomy/Uterine Exteriorization Technique
Intervention Description
The laparotomy/uterine exteriorization technique uses endoscopes through an open abdomen and closed, exteriorized uterus to perform the spina bifida correction.
Primary Outcome Measure Information:
Title
Ability to perform the endoscopic procedure
Description
Successful fetoscopic closure of the defect
Time Frame
At time of surgery
Secondary Outcome Measure Information:
Title
Chiari II malformation reversal
Description
Reversal of hindbrain herniation on ultrasound and MRI
Time Frame
Prior to delivery

10. Eligibility

Sex
Female
Gender Based
Yes
Gender Eligibility Description
Gravid female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
52 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Myelomeningocele (including myeloschisis) at level T1 through S1 with hindbrain herniation. Lesion level and hindbrain herniation will be confirmed by MRI and ultrasonography. Maternal age ≥18 years. Gestational age of 19 to 27 6/7 weeks' gestation as determined by clinical information and evaluation of first ultrasound. Balanced karyotype and/or normal mircoarray with written confirmation of culture results. Results by fluorescence in situ hybridization (FISH) will be acceptable if the patient is at 24 weeks or more. Positive evaluation of social work consult indicating the patient is capable of consenting to the procedure and has the appropriate social support system to participate in the study. Positive evaluation from pediatric neurology consult. Willing to return to our center, or to a multi-disciplinary spina bifida clinic closer to their home for the 6, 12, 24, 30, 48, and 60 months follow-up evaluations. Exclusion Criteria: Multiple gestation Insulin-dependent pregestational diabetes Presence of a fetal anomaly not related to Chiari II Malformation. A fetal echocardiogram will be conducted before surgery and if the finding is abnormal, the patient will be excluded. Fetal kyphosis of 30 degrees or more, assessed by ultrasound or MRI. Presence of uterine cervical cerclage or history of incompetent cervix. Placenta previa or placental abruption. Short cervix < 25 mm measured by cervical ultrasound. Obesity as defined by body mass index (BMI) of 40 or greater. History of previous spontaneous singleton delivery prior to 37 weeks. Maternal-fetal Rh isoimmunization, Kell sensitization or a history of neonatal alloimmune thrombocytopenia. Maternal HIV or Hepatitis-B status positive because of the increased risk of transmission to the fetus during maternal-fetal surgery. If the patient's HIV or Hepatitis B status is unknown, the patient must be tested and found to have negative results before she can be enrolled. Known Hepatitis-C positivity. If the patient's Hepatitis C status is unknown, she does not need to be screened. Uterine anomaly such as large (greater than 6 cm) fibroids, cervical fibroids or multiple fibroids or Mullerian duct abnormality. Other maternal medical condition which is a contraindication to surgery or anesthesia. Patient does not have a support person (e.g., husband, partner, parents). Inability to comply with the travel and follow-up requirements of the study. Patient does not meet psychosocial criteria as determined by the social worker evaluation. Participation in another intervention study that influences maternal and fetal morbidity and mortality. Maternal hypertension as determined by the investigator, which would increase the risk of preeclampsia or preterm delivery (including, but not limited to: uncontrolled hypertension, chronic hypertension with end organ damage and new onset hypertension in current pregnancy). Bicornuate uterus or any other uterine malformation the PI decides is not safe for surgery. Nickel allergy. Maternal request to undergo open fetal surgery for the antenatal correction of OSB at our institution primarily or after failed fetoscopic approach. Known maternal hypersensitivity to bovine collagen or chondroitin materials.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Ruben Quintero, MD
Phone
720-753-3825
Email
q@the-fetal-institute.com
First Name & Middle Initial & Last Name or Official Title & Degree
Ramen Chmait, MD
Phone
213-469-6277
Email
chmait@usc.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ruben Quintero, MD
Organizational Affiliation
US Fetus
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Ramen Chmait, MD
Organizational Affiliation
University of Southern California
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hollywood Presbyterian Medical Center
City
Los Angeles
State/Province
California
ZIP/Postal Code
90027
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ramen Chmait, MD
Phone
213-469-6277
Email
chmait@usc.edu
First Name & Middle Initial & Last Name & Degree
Arlyn Llanes, RN
Phone
213-469-6277
Email
arlyn.llanes@med.usc.edu
Facility Name
Wellington Regional Medical Center
City
Wellington
State/Province
Florida
ZIP/Postal Code
33141
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ruben Quintero, MD
Phone
720-753-3825
First Name & Middle Initial & Last Name & Degree
Eftichia Kontopoulos, MD
Phone
720-753-3825

12. IPD Sharing Statement

Learn more about this trial

In-Utero Endoscopic Correction of Spina Bifida

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