{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T15:20:38Z","timestamp":1776525638943,"version":"3.51.2"},"reference-count":69,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,2,28]],"date-time":"2018-02-28T00:00:00Z","timestamp":1519776000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["WT101957"],"award-info":[{"award-number":["WT101957"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000266","name":"Engineering and Physical Sciences Research Council","doi-asserted-by":"publisher","award":["NS\/A000027\/1"],"award-info":[{"award-number":["NS\/A000027\/1"]}],"id":[{"id":"10.13039\/501100000266","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Prenatal Diagnosis"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the safety and efficacy of different neurosurgical techniques for closure of spina bifida (SB) in the fetal lamb model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Systematic review of studies reporting on fetal lambs undergoing induction and closure of SB compared with non\u2010operated normal lambs (negative controls) and\/or lambs not undergoing closure of the defect (positive controls). Primary outcomes were (1) survival at birth (safety) and\/or (2) presence of Somatosensory Evoked Potentials on hind limbs and\/or improvement in quantitative histological spinal cord findings and\/or reversal of hindbrain herniation (efficacy).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of 1311, 36 full\u2010text articles were eligible. Nineteen were included for quality assessment. Due to high bias, only 2 adequately powered studies were included in the final analysis. An open approach using a 2\u2010layer closure (muscle flap or acellular\u2010dermal\u2010matrix patch plus skin) was the only safe (patch\u00a0+\u00a0skin) and effective (both techniques) technique for prenatal closure in this animal model. No comparable level of evidence was identified for other techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The experimental literature on prenatal SB closure underscores the lack of standardization. At present, there is animal experimental evidence that a 2\u2010layer closure by hysterotomy is safe and effective. This technique is currently clinically used in a subset of patients. As new clinical techniques are introduced, it would seem logic to preclinically validate them against this experimental standard.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pd.5222","type":"journal-article","created":{"date-parts":[[2018,2,1]],"date-time":"2018-02-01T04:06:35Z","timestamp":1517457995000},"page":"231-242","source":"Crossref","is-referenced-by-count":27,"title":["Safety and efficacy of fetal surgery techniques to close a spina bifida defect in the fetal lamb model: A systematic review"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7331-6354","authenticated-orcid":false,"given":"Luc","family":"Joyeux","sequence":"first","affiliation":[{"name":"Academic Department Development and Regeneration, Cluster Organ Systems, Biomedical Sciences, Faculty of Medicine Katholieke Universiteit (KU) Leuven  Leuven Belgium"},{"name":"Center for Surgical Technologies, Faculty of Medicine KU Leuven  Leuven Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"De Bie","sequence":"additional","affiliation":[{"name":"Center for Surgical Technologies, Faculty of Medicine KU Leuven  Leuven Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Danzer","sequence":"additional","affiliation":[{"name":"Center for Fetal Diagnosis and Treatment, the Children's Hospital of Philadelphia and the Perelman School of Medicine University of Pennsylvania  Philadelphia PA USA"},{"name":"Department of Surgery, Children's Center for Fetal Research, Abramson Research center the Children's Hospital of Philadelphia  Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3034-6905","authenticated-orcid":false,"given":"Tim","family":"Van Mieghem","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fetal Medicine Unit, Mt. 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