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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Data availability

Data supporting the findings of this study are available within the article.

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Acknowledgements

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.

Funding

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

Author information

Author notes

  1. Soner Duru and Marc Oria contributed equally to this work.

Authors and Affiliations

  1. Center for Fetal and Placental Research, Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center (CCHMC), 3333 Burnet Avenue, MLC 11025, Cincinnati, OH, 45229-3039, USA

    Soner Duru, Marc Oria & Jose L. Peiro

  2. Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Barcelona, Spain

    Silvia Arevalo & Carlota Rodo

  3. Jesus Usón Minimally Invasive Surgery Centre (JUMISC), Caceres, Spain

    Laura Correa & Francisco Sanchez-Margallo

  4. Department of Pediatric Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile

    Fernando Vuletin

Authors
  1. Soner Duru
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  2. Marc Oria
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  3. Silvia Arevalo
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  4. Carlota Rodo
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  5. Laura Correa
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  6. Fernando Vuletin
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  7. Francisco Sanchez-Margallo
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  8. Jose L. Peiro
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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.

Corresponding author

Correspondence to Jose L. Peiro.

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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.

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The authors read and approved the final manuscript.

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Duru, S., Oria, M., Arevalo, S. et al. Comparative study of intracisternal kaolin injection techniques to induce congenital hydrocephalus in fetal lamb. Childs Nerv Syst 35, 843–849 (2019). https://doi.org/10.1007/s00381-019-04096-1

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  • DOI: https://doi.org/10.1007/s00381-019-04096-1

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