Child's Nervous System

, Volume 35, Issue 5, pp 843–849 | Cite as

Comparative study of intracisternal kaolin injection techniques to induce congenital hydrocephalus in fetal lamb

  • Soner Duru
  • Marc Oria
  • Silvia Arevalo
  • Carlota Rodo
  • Laura Correa
  • Fernando Vuletin
  • Francisco Sanchez-Margallo
  • Jose L. PeiroEmail author
Original Article



Kaolin (aluminum silicate) has been used to generate hydrocephalus by direct cisterna magna injection in animal models. The aim of the present study is to compare which method of Kaolin injection into fetal cisterna magna is feasible, safer, and more effective to induce hydrocephalus in fetal lambs.


Twenty-five well-dated pregnant ewes at gestational 85–90 days (E85-90) were used to compare three different kaolin injection puncture techniques into the fetal cisterna magna. Group 1, ultrasound guidance in a maternal percutaneous transabdominal (TA); group 2, without opening the uterus in a transuterine (TU) technique; group 3, by occipital direct access after exteriorizing fetal head (EFH); and group 4, control group, was normal fetal lambs without injection. The fetal lambs were assessed using lateral ventricle diameter ultrasonographic measurements prior the kaolin injection and on the subsequent days. We analyzed the effectivity, mortality, and fetal losses to determine the best technique to create hydrocephalus in fetal lamb.


After fetal intracisternal kaolin (2%, 1mL) injection, lateral ventricle diameters increased progressively in the three different interventional groups compared with the normal values of the control group (p ≤ 0.05). We observed that the transabdominal method had a 60% of fetal losses, considering failure of injection and mortality, compared with the 12.5% in the open group (EFH), and 0% for the transuterine group.


Based on our study, we believe that both, open uterine (EFH) and transuterine approaches are more effective and safer than the transabdominal ultrasound-guided method to induce hydrocephalus.


Fetal Hydrocephalus Kaolin Sheep Ventriculomegaly 



The authors acknowledge all the veterinary professionals that took care of anesthesia and maintenance of the pregnant sheep in the excellent facilities at the JUMISC.

Authors’ contributions

Study concept and design: S.D., M.O., and JL.P.

Acquisition of data: M.O., S.A., C.R., L.C., F.V., F. SM., and JL.P.

Analysis and interpretation of data: S.D., M.O., and JL.P.

Drafting of the manuscript: M.O., S.D., and JL.P.

Critical revision of the manuscript for important intellectual content: M.O., S.D., and JL.P.

Statistical analysis: M.O.

Obtained funding: JL.P.

Technical or material support: M.O.

Study supervision: S.D. and JL.P.


This work was supported by Prof. Jose L Peiro Internal Cincinnati Children’s Hospital funding.

Compliance with ethical standards

Conflict of interest

Authors have no competing interests.

Ethical approval

This study was performed according to the European Council Directives (C86/609/EEC and 200/65/EC) and Spanish Guidelines for the Use of Laboratory Animals and the approval of the official regional governmental IACUC (ES100370001499), and local ethics committee for experimental animal use at the animal facilities of the Jesus Usón Minimally Invasive Surgery Centre (JUMISC) in Spain.

Consent for publication

The authors read and approved the final manuscript.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Soner Duru
    • 1
  • Marc Oria
    • 1
  • Silvia Arevalo
    • 2
  • Carlota Rodo
    • 2
  • Laura Correa
    • 3
  • Fernando Vuletin
    • 4
  • Francisco Sanchez-Margallo
    • 3
  • Jose L. Peiro
    • 1
    Email author
  1. 1.Center for Fetal and Placental Research, Division of Pediatric General and Thoracic SurgeryCincinnati Children’s Hospital Medical Center (CCHMC)CincinnatiUSA
  2. 2.Maternal-Fetal Medicine Unit, Department of ObstetricsHospital Universitari Vall d’HebronBarcelonaSpain
  3. 3.Jesus Usón Minimally Invasive Surgery Centre (JUMISC)CaceresSpain
  4. 4.Department of Pediatric SurgeryPontificia Universidad Católica de ChileSantiagoChile

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