Live Event Content
Aqueductal Stenosis
Everything in the library about aqueductal stenosis — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Evidence & Research
2 items
2024 Fetal Care Center Frontiers in Fetal Neurology Day 1 - Dr. Dawn Gano
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Dr. Dawn Gano speaks on the fetal intracranial hemorrhage on Day 1 of the Frontiers in Fetal Neurology 2-day interactive webinar series.
video16:09 · Oct 2024
2024 Fetal Care Center Frontiers in Fetal Neurology Day 1 - Dr. Jose Peiro
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Dr. Jose Peiro speaks on the fetal intracranial hemorrhage on Day 1 of the Frontiers in Fetal Neurology 2-day interactive webinar series.
video16:09 · Oct 2024
Emerging & Future Directions
1 item
IFMSS 2019 Techincal & Educational Innovation
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podcast14:13 · Nov 2022
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
IFMSS 2019 Techincal & Educational Innovation
Aqueductal stenosis is associated with poor neurologic outcomes
clinicalSteven Emery0:30 ↗
In the 1980s fetal shunting for hydrocephalus was attempted but failed because accurate diagnosis of pressure hydrocephalus was not possible, leading to shunts being placed in babies with hydranencephaly, Dandy-Walker malformation, and other anomalies
clinicalSteven Emery0:40 ↗
When the 1980s shunting data are scrutinized, babies who had aqueductal stenosis on postnatal evaluation actually benefited from shunting
clinicalSteven Emery1:30 ↗
IFMSS put a moratorium on fetal shunting in 1986
guidelineSteven Emery1:50 ↗
Current management of fetal aqueductal stenosis is observation until near term (37 weeks) followed by assisted delivery, usually by cesarean section, sometimes classical cesarean with vertical skin incision due to large head size
clinicalSteven Emery2:00 ↗
The research team developed an animal model that reliably and reproducibly generates mid-trimester hydrocephalus and designed a shunt device from scratch that is near design freeze
clinicalSteven Emery2:30 ↗
Decompressing intracranial pressure with a shunt will allow the fetal brain to continue to develop normally and heal from injury that has already occurred
opinionSteven Emery3:00 ↗
The research agenda presented in 2014 at IFMSS received phenomenal support from the investigators who instituted the 1986 moratorium, including Mike Harrison and Bill Kluwell
clinicalSteven Emery3:35 ↗
The hydrocephalus shunt is purpose-designed specifically for fetuses, which is very unique in fetal medicine where devices are usually borrowed from other applications
opinionSteven Emery4:21 ↗
The MOMS trial demonstrated that in utero surgery for spina bifida, performed as early as possible, clearly improves outcomes in these babies
host_summaryJose Piero5:13 ↗
During in utero and postnatal spina bifida repair, it is very frequent not to have enough skin or dura for recovery of the lesions, requiring use of dural patches or substitutes
clinicalJose Piero5:30 ↗
Many dural substitute materials exist on the market but none is demonstrated to be ideal for spina bifida repair
clinicalJose Piero5:50 ↗
The Cincinnati team developed a patch using a blend of two FDA-cleared polymers (PEA-PCL) that is thin, can be coiled by body temperature, displays and uncoils automatically, is biodegradable, non-toxic, and spinal cord friendly
clinicalJose Piero6:05 ↗
The PEA-PCL patch is an acellular synthetic patch that disappears around one year and does not need to be removed
clinicalJose Piero6:50 ↗
The patch development timeline from concept to market readiness is approximately 5 years, starting with in vitro testing, then in vivo testing in rats, then in fetal lambs
clinicalJose Piero7:18 ↗
During twin-twin transfusion syndrome laser ablation, the procedure is limited by a very limited field of view, making it hard for the surgeon to orient and navigate to find anastomoses
clinicalAnuk van der Schot8:03 ↗
The Radboud team is creating a real-time panoramic view of the placental surface (a 'Google Maps for fetal surgery') to help surgeons make decisions and reduce complications associated with prolonged or incomplete surgery
clinicalAnuk van der Schot8:30 ↗
The panoramic imaging algorithm uses only the visual information from the standard fetoscope without requiring extra hardware or sensors, similar to panoramic view on a phone camera
clinicalAnuk van der Schot9:10 ↗
The panoramic imaging software could potentially work with any standard fetoscopy equipment and could be applied to other disciplines like bronchoscopy or laparoscopy
opinionAnuk van der Schot9:30 ↗
Fetoscopic spina bifida repair has many technical challenges in planning, preparation, and team training
clinicalGina Miller9:56 ↗
The Johns Hopkins team developed a modular 3D printing system to create patient-matched models for practice before each individual spina bifida case
clinicalGina Miller10:20 ↗
The 3D-printed models show very good visual correlation with the lesion at surgery and very high correlation with the number of sutures and how the repair actually goes
clinicalGina Miller10:50 ↗
The modular 3D printing system is very cheap and efficient, suitable for rapid prototyping that anyone can easily incorporate into clinical practice
opinionGina Miller11:20 ↗
The workflow from ultrasound volume to 3D print takes a little over half an hour on a desktop printer, and surgical rehearsal is done with the core team within the week before surgery
clinicalGina Miller11:50 ↗
The rapid print uses standard ABS filament (hard material) or Ninja Flex (soft and flexible material)
clinicalGina Miller12:29 ↗
The team is close to completing standardization of the different components and has added features to the host model to make skin covering application easier and add the instability experienced in the OR
clinicalGina Miller13:11 ↗
2024 Fetal Care Center Frontiers in Fetal Neurology Day 1 - Dr. Jose Peiro
CSF produced in the choroid plexus circulates through the ventricular system via the aqueduct of Sylvius and fourth ventricle, then around the brain for reabsorption.
clinicalJose Peiro0:12 ↗
Aqueductal stenosis blocks normal CSF circulation, causing fluid buildup in lateral and third ventricles, representing a pure obstructive problem in fetuses and babies.
clinicalJose Peiro1:00 ↗
Progressive ventricular enlargement in obstructive hydrocephalus causes increased intracranial pressure, cortical mantle thinning, rupture of septum pellucidum, and denudation of ependyma, producing problems in brain development.
clinicalJose Peiro1:30 ↗
Ventriculomegaly and hydrocephalus can be detected very early in gestation using prenatal ultrasound, classified as mild, moderate, or severe.
clinicalJose Peiro2:00 ↗
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