Jose Peiro

241 timestamped statements across 6 topics — auto-found in recorded discussions, each timestamp jumps to the exact moment. Summaries Jose gave as host are listed separately below.

Fetal Surgery · guest expert

Featured statements

▶ Ep 24 · 3:12
Open fetal surgery still is used for large, solid masses in the chest, for sacrococcial teratomass, and also for spina bifida.
quote · Congenital Pulmonary Airway Malformation
▶ Ep 3 · 1:30
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.
clinical · Aqueductal Stenosis
▶ Ep 24 · 8:58
The EXIT procedure is performed at delivery for conditions that can cause neonatal asphyxia or difficult intubation, such as neck masses compressing the trachea, congenital airway obstruction, or severe micrognathia.
clinical · Congenital Pulmonary Airway Malformation
▶ Ep 3 · 12:20
Fetal ETV in the lamb model is performed using a 7 French rigid fetoscope or cystoscope inserted through the coronal suture approximately 1 centimeter to the midline to enter the lateral ventricle.
clinical · Aqueductal Stenosis
▶ Ep 24 · 9:48
During EXIT for neck teratomas, if intubation is not possible with rigid instruments or laryngoscopy, partial resection of the teratoma can be performed to identify the trachea and then intubate.
clinical · Congenital Pulmonary Airway Malformation
▶ Ep 4 · 14:10
A rigid plastic fiber (laser without energy) is used to create a blunt opening in the third ventricle floor to avoid energy-related damage to the basilar artery in mid-gestation fetuses.
clinical · Hydrocephalus

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Jose's statements about Aqueductal Stenosis 38 statements

Open the Aqueductal Stenosis collection →

2024 Fetal Care Center Frontiers in Fetal Neurology Day 1 - Dr. Jose Peiro

▶ Ep 3 · 0:12
clinical 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. ↗
▶ Ep 3 · 1:00
clinical Aqueductal stenosis blocks normal CSF circulation, causing fluid buildup in lateral and third ventricles, representing a pure obstructive problem in fetuses and babies. ↗
▶ Ep 3 · 1:30
clinical 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. ↗
▶ Ep 3 · 2:00
clinical Ventriculomegaly and hydrocephalus can be detected very early in gestation using prenatal ultrasound, classified as mild, moderate, or severe. ↗
▶ Ep 3 · 2:20
clinical MRI is a very good tool to complete prenatal hydrocephalus evaluation and identify isolated aqueductal stenosis with genetic testing. ↗
▶ Ep 3 · 3:00
clinical Aqueductal stenosis is probably the most important cause of obstructive congenital hydrocephalus. ↗
▶ Ep 3 · 3:20
clinical Fetal hydrocephalus is associated with potentially poor outcomes including intellectual disabilities, spasticity, and seizures. ↗
▶ Ep 3 · 3:40
clinical Postnatal treatment of congenital hydrocephalus almost consistently requires CSF diversion, mostly with VP shunts, which have problems including malfunction and infection. ↗
▶ Ep 3 · 4:30
quote we know that any of these treatment postnatally probably arrives late because during the intrauterine period, uh there's a progressive brain deterioration ↗
▶ Ep 3 · 4:30
opinion Any postnatal treatment probably arrives late because progressive brain deterioration occurs during the intrauterine period, including denudation, astrocytosis, and microgliosis. ↗
▶ Ep 3 · 5:00
quote what about to do something before birth, right? Uh, as soon as possible just to stop this problem in the brain development. What about do a prenatal fetal ETV ↗
▶ Ep 3 · 6:00
clinical The first attempts at fetal hydrocephalus treatment were performed in fetal monkeys and chimp models using ventriculo-amniotic shunts approximately 40 years ago. ↗
▶ Ep 3 · 6:30
clinical The first human case of fetal hydrocephalus treatment was described by Birnholz, and 44 cases were collected in a registry and discussed at a 1982 fetal medicine and surgery meeting. ↗
▶ Ep 3 · 7:00
clinical Experts in fetal surgery decided on a moratorium on fetal hydrocephalus intervention after the 1982 meeting, likely due to suboptimal clinical outcomes and patient selection. ↗
▶ Ep 3 · 7:30
quote after 40 years, right, right now, and we have more technology, better imaging and genetic tools for better patient selection, so, it makes sense that possibility to recapitulate these uh treatments, but in my opinion, not to put any hardware, any, any shunt, just to try the ETB, make a hole and go ↗
▶ Ep 3 · 7:30
opinion Modern technology, better imaging, and genetic tools for patient selection make it sensible to reconsider fetal hydrocephalus treatment, specifically fetal ETV without hardware. ↗
▶ Ep 3 · 8:00
clinical In the fetal lamb model, kaolin injected into the cisterna magna creates moderate hydrocephalus but causes a meningitis-like irritation reaction. ↗
▶ Ep 3 · 8:40
quote we discovered that uh we can create in all the models. Uh, moderate hydrocephalus ↗
▶ Ep 3 · 9:00
quote we determined that uh analyzing all these groups in comparing Kaoline, Bioglue, and onyx, we decided uh that Bioglue was the best ↗
▶ Ep 3 · 9:00
clinical Comparing kaolin, bioglue, and onyx for creating fetal lamb hydrocephalus, bioglue was determined to be the best agent. ↗
▶ Ep 3 · 9:30
clinical A severity scale for fetal lamb hydrocephalus was developed with mild, moderate, and severe categories based on ventricular measurements. ↗
▶ Ep 3 · 10:00
clinical Only bioglue allowed creation of severe hydrocephalus cases in the fetal lamb model, with significant cortical thinning. ↗
▶ Ep 3 · 10:30
clinical The fetal lamb hydrocephalus model shows ependymal denudation with loss of cilia, likely due to ventricular distension. ↗
▶ Ep 3 · 11:00
clinical The percentage of ependymal denudation is higher with severe category hydrocephalus and occurs very early in gestation until delivery. ↗
▶ Ep 3 · 11:30
clinical Astrocytes replace ependymal cells and create scar tissue in areas of denudation. ↗
▶ Ep 3 · 11:50
clinical Activated microglia indicating neuroinflammation are present in areas of ependymal denudation, putting neuroprogenitor cells in the subventricular zone at risk of maldevelopment. ↗
▶ Ep 3 · 12:20
clinical Fetal ETV in the lamb model is performed using a 7 French rigid fetoscope or cystoscope inserted through the coronal suture approximately 1 centimeter to the midline to enter the lateral ventricle. ↗
▶ Ep 3 · 13:00
clinical The fetal lamb brain anatomy is more elongated than human, with a narrow foramen of Monro and other anatomical differences that create technical difficulties. ↗
▶ Ep 3 · 13:30
clinical In the fetal lamb model, the septum pellucidum is absent in hydrocephalus, allowing visualization of both lateral ventricles. ↗
▶ Ep 3 · 13:50
clinical The interthalamic adhesion in fetal lambs is very large, making the anatomy different from human. ↗
▶ Ep 3 · 14:10
clinical A rigid plastic fiber (laser without energy) is used to create a blunt opening in the third ventricle floor to avoid energy-related damage to the basilar artery in mid-gestation fetuses. ↗
▶ Ep 3 · 14:40
clinical Fetal ETV in the lamb model reduced ventricular size from severe to moderate-mild and from moderate to normal in most cases. ↗
▶ Ep 3 · 15:00
clinical A fetal surgeon in Brazil has performed percutaneous fetal ETV in 10 human cases with no deaths, demonstrating feasibility and safety. ↗
▶ Ep 3 · 15:10
clinical Fetal ETV improved cortical thickness (reduced compression) in treated fetal lambs. ↗
▶ Ep 3 · 15:30
quote We don't know if we prevent denudation or we are regenerating after recirculation and deflation of the ventricles, but we are working on that ↗
▶ Ep 3 · 15:30
clinical In most cases, fetal ETV recovered ependymal denudation, though it is unknown whether this represents prevention or regeneration after ventricular deflation. ↗
▶ Ep 3 · 15:40
quote I think we are ready just to start in USA ↗
▶ Ep 3 · 15:40
clinical A multi-center U.S. clinical trial is planned, starting with phase 1 in 10 human cases to assess safety and feasibility, followed by phase 2 in 50-60 cases to assess efficacy. ↗
Jose's statements about Congenital Pulmonary Airway Malformation 33 statements

Open the Congenital Pulmonary Airway Malformation collection →

Open Fetal Surgery & EXIT Procedure with Dr. Jose Peiro

▶ Ep 24 · 0:33
quote The answer is very easy. It's just because we have prenatal diagnosis. ↗
▶ Ep 24 · 0:38
quote So in other words, we can detect things in utero very early in gestation. ↗
▶ Ep 24 · 0:47
quote The most important is the prenatal ultrasounds. The conventional ultrasounds at mid gestation around 20 weeks will be the best. ↗
▶ Ep 24 · 0:47
clinical Prenatal ultrasound at mid-gestation around 20 weeks is the best tool for detecting fetal malformations, with high detection rates in developed countries. ↗
▶ Ep 24 · 1:27
clinical Doppler ultrasound can assess fetal hemodynamic status by measuring flows in the umbilical artery, ductus venosus, and middle cerebral artery. ↗
▶ Ep 24 · 1:43
clinical Fetal MRI contributes to diagnosis definition after ultrasound, especially for findings in the brain, chest, and abdomen. ↗
▶ Ep 24 · 2:04
quote So that's the goal of fetal intervention. Just try to rescue or improve these conditions. ↗
▶ Ep 24 · 2:13
clinical In gastroschisis, earlier delivery can reduce bowel injury, resulting in less serositis and better recovery. ↗
▶ Ep 24 · 2:29
quote Open fetal surgery is the most similar to neonatal surgery, so we have the patient in our hands. We can operate in a fetus the same as we operate in a preemie. ↗
▶ Ep 24 · 2:37
quote The only problem is we need to open the uterus. ↗
▶ Ep 24 · 3:01
quote For that reason, all the fetal surgeons were trying to go away from fetal surgery, trying to look for minimally invasive surgery. ↗
▶ Ep 24 · 3:12
clinical Open fetal surgery is still used for large solid chest masses, sacrococcygeal teratomas, and spina bifida. ↗
▶ Ep 24 · 3:12
quote Open fetal surgery still is used for large, solid masses in the chest, for sacrococcial teratomass, and also for spina bifida. ↗
▶ Ep 24 · 3:30
clinical Solid CPAM lesions grow rapidly and can cause mediastinal shift, compression of the contralateral lung and heart, leading to hydrops fetalis. ↗
▶ Ep 24 · 3:49
clinical Hydrops fetalis (ascites, pleural effusion, scalp edema, anasarca) is very close to fetal demise and is the usual outcome if untreated. ↗
▶ Ep 24 · 3:57
quote So hydros fetalis is very close to be complete a fetal demise. That is the usual outcome of these babies if we don't do nothing. ↗
▶ Ep 24 · 4:25
quote Everything that measures less than 1.6 is very, very low risk of developed eye drops. On the contrary, more than 1.6, we have high risk of eye drops and complications. ↗
▶ Ep 24 · 4:25
clinical CVR less than 1.6 indicates very low risk of hydrops; CVR greater than 1.6 indicates high risk of hydrops and complications. ↗
▶ Ep 24 · 4:53
epidemiological Steroids rescue more than half of CPAM cases; the remaining 40% do not respond well. ↗
▶ Ep 24 · 4:53
quote It's a good rescue in more than half of these babies. So, the other half or 40%, probably don't respond very well. ↗
▶ Ep 24 · 5:01
clinical Before 30 weeks, cystic CPAM can be treated with a shunt; solid CPAM requires open fetal surgery and lobectomy. ↗
▶ Ep 24 · 5:22
clinical Solid sacrococcygeal teratomas are more dangerous than cystic ones due to rapid growth and vascularization visible on Doppler. ↗
▶ Ep 24 · 5:32
clinical The Altman classification used postnatally can also be applied to prenatal MRI to determine teratoma type and need for intervention. ↗
▶ Ep 24 · 5:51
guideline Open fetal surgery is the gold standard for spina bifida, though other innovations are in development. ↗
▶ Ep 24 · 6:04
clinical Spina bifida originates at approximately 4 weeks of embryonic time when the neural tube fails to close. ↗
▶ Ep 24 · 6:16
clinical In spina bifida, the exposed spinal cord is damaged by contact with amniotic fluid rich in meconium and enzymes (the 'second hit'), progressively destroying neural tissue and nerves. ↗
▶ Ep 24 · 7:28
clinical Hydrocephalus in spina bifida requires ventriculoperitoneal shunting and causes migration disorders and heterotopia. ↗
▶ Ep 24 · 7:51
clinical The rationale for fetal spina bifida repair is to prevent amniotic fluid from touching the nerves and to stop CSF leak. ↗
▶ Ep 24 · 8:34
clinical In fetoscopic spina bifida repair, a collagen patch is introduced through the cannula for duroplasty, maintained with one stitch, followed by primary skin closure or patch. ↗
▶ Ep 24 · 8:58
clinical The EXIT procedure is performed at delivery for conditions that can cause neonatal asphyxia or difficult intubation, such as neck masses compressing the trachea, congenital airway obstruction, or severe micrognathia. ↗
▶ Ep 24 · 9:25
clinical During EXIT, placental oxygenation can be maintained for 1 to 3 hours, providing a controlled situation without need to rush airway securement. ↗
▶ Ep 24 · 9:48
clinical During EXIT for neck teratomas, if intubation is not possible with rigid instruments or laryngoscopy, partial resection of the teratoma can be performed to identify the trachea and then intubate. ↗
▶ Ep 24 · 10:10
clinical Once intubation is achieved during EXIT, the cord is clamped and complete teratoma resection is performed in an adjacent operating room. ↗
Jose's statements about Congenital Pulmonary Airway Malformation 33 statements

Open the Congenital Pulmonary Airway Malformation collection →

Open Fetal Surgery & EXIT Procedure with Dr. Jose Peiro

▶ Ep 24 · 0:33
quote The answer is very easy. It's just because we have prenatal diagnosis. ↗
▶ Ep 24 · 0:38
quote So in other words, we can detect things in utero very early in gestation. ↗
▶ Ep 24 · 0:47
clinical Prenatal ultrasound at mid-gestation around 20 weeks is the best tool for detecting fetal malformations, with high detection rates in developed countries. ↗
▶ Ep 24 · 0:47
quote The most important is the prenatal ultrasounds. The conventional ultrasounds at mid gestation around 20 weeks will be the best. ↗
▶ Ep 24 · 1:27
clinical Doppler ultrasound can assess fetal hemodynamic status by measuring flows in the umbilical artery, ductus venosus, and middle cerebral artery. ↗
▶ Ep 24 · 1:43
clinical Fetal MRI contributes to diagnosis definition after ultrasound, especially for findings in the brain, chest, and abdomen. ↗
▶ Ep 24 · 2:04
quote So that's the goal of fetal intervention. Just try to rescue or improve these conditions. ↗
▶ Ep 24 · 2:13
clinical In gastroschisis, earlier delivery can reduce bowel injury, resulting in less serositis and better recovery. ↗
▶ Ep 24 · 2:29
quote Open fetal surgery is the most similar to neonatal surgery, so we have the patient in our hands. We can operate in a fetus the same as we operate in a preemie. ↗
▶ Ep 24 · 2:37
quote The only problem is we need to open the uterus. ↗
▶ Ep 24 · 3:01
quote For that reason, all the fetal surgeons were trying to go away from fetal surgery, trying to look for minimally invasive surgery. ↗
▶ Ep 24 · 3:12
clinical Open fetal surgery is still used for large solid chest masses, sacrococcygeal teratomas, and spina bifida. ↗
▶ Ep 24 · 3:12
quote Open fetal surgery still is used for large, solid masses in the chest, for sacrococcial teratomass, and also for spina bifida. ↗
▶ Ep 24 · 3:30
clinical Solid CPAM lesions grow rapidly and can cause mediastinal shift, compression of the contralateral lung and heart, leading to hydrops fetalis. ↗
▶ Ep 24 · 3:49
clinical Hydrops fetalis (ascites, pleural effusion, scalp edema, anasarca) is very close to fetal demise and is the usual outcome if untreated. ↗
▶ Ep 24 · 3:57
quote So hydros fetalis is very close to be complete a fetal demise. That is the usual outcome of these babies if we don't do nothing. ↗
▶ Ep 24 · 4:25
clinical CVR less than 1.6 indicates very low risk of hydrops; CVR greater than 1.6 indicates high risk of hydrops and complications. ↗
▶ Ep 24 · 4:25
quote Everything that measures less than 1.6 is very, very low risk of developed eye drops. On the contrary, more than 1.6, we have high risk of eye drops and complications. ↗
▶ Ep 24 · 4:53
quote It's a good rescue in more than half of these babies. So, the other half or 40%, probably don't respond very well. ↗
▶ Ep 24 · 4:53
epidemiological Steroids rescue more than half of CPAM cases; the remaining 40% do not respond well. ↗
▶ Ep 24 · 5:01
clinical Before 30 weeks, cystic CPAM can be treated with a shunt; solid CPAM requires open fetal surgery and lobectomy. ↗
▶ Ep 24 · 5:22
clinical Solid sacrococcygeal teratomas are more dangerous than cystic ones due to rapid growth and vascularization visible on Doppler. ↗
▶ Ep 24 · 5:32
clinical The Altman classification used postnatally can also be applied to prenatal MRI to determine teratoma type and need for intervention. ↗
▶ Ep 24 · 5:51
guideline Open fetal surgery is the gold standard for spina bifida, though other innovations are in development. ↗
▶ Ep 24 · 6:04
clinical Spina bifida originates at approximately 4 weeks of embryonic time when the neural tube fails to close. ↗
▶ Ep 24 · 6:16
clinical In spina bifida, the exposed spinal cord is damaged by contact with amniotic fluid rich in meconium and enzymes (the 'second hit'), progressively destroying neural tissue and nerves. ↗
▶ Ep 24 · 7:28
clinical Hydrocephalus in spina bifida requires ventriculoperitoneal shunting and causes migration disorders and heterotopia. ↗
▶ Ep 24 · 7:51
clinical The rationale for fetal spina bifida repair is to prevent amniotic fluid from touching the nerves and to stop CSF leak. ↗
▶ Ep 24 · 8:34
clinical In fetoscopic spina bifida repair, a collagen patch is introduced through the cannula for duroplasty, maintained with one stitch, followed by primary skin closure or patch. ↗
▶ Ep 24 · 8:58
clinical The EXIT procedure is performed at delivery for conditions that can cause neonatal asphyxia or difficult intubation, such as neck masses compressing the trachea, congenital airway obstruction, or severe micrognathia. ↗
▶ Ep 24 · 9:25
clinical During EXIT, placental oxygenation can be maintained for 1 to 3 hours, providing a controlled situation without need to rush airway securement. ↗
▶ Ep 24 · 9:48
clinical During EXIT for neck teratomas, if intubation is not possible with rigid instruments or laryngoscopy, partial resection of the teratoma can be performed to identify the trachea and then intubate. ↗
▶ Ep 24 · 10:10
clinical Once intubation is achieved during EXIT, the cord is clamped and complete teratoma resection is performed in an adjacent operating room. ↗
Jose's statements about Fetal Surgery 66 statements

Open the Fetal Surgery collection →

Open Fetal Surgery & EXIT Procedure with Dr. Jose Peiro

▶ Ep 23 · 0:33
quote The answer is very easy. It's just because we have prenatal diagnosis. ↗
▶ Ep 23 · 0:33
quote The answer is very easy. It's just because we have prenatal diagnosis. ↗
▶ Ep 23 · 0:38
quote So in other words, we can detect things in utero very early in gestation. ↗
▶ Ep 23 · 0:38
quote So in other words, we can detect things in utero very early in gestation. ↗
▶ Ep 23 · 0:47
quote The most important is the prenatal ultrasounds. The conventional ultrasounds at mid gestation around 20 weeks will be the best. ↗
▶ Ep 23 · 0:47
clinical Prenatal ultrasound at mid-gestation around 20 weeks is the best tool for detecting fetal malformations, with high detection rates in developed countries. ↗
▶ Ep 23 · 0:47
clinical Prenatal ultrasound at mid-gestation around 20 weeks is the best tool for detecting fetal malformations, with high detection rates in developed countries. ↗
▶ Ep 23 · 0:47
quote The most important is the prenatal ultrasounds. The conventional ultrasounds at mid gestation around 20 weeks will be the best. ↗
▶ Ep 23 · 1:27
clinical Doppler ultrasound can assess fetal hemodynamic status by measuring flows in the umbilical artery, ductus venosus, and middle cerebral artery. ↗
▶ Ep 23 · 1:27
clinical Doppler ultrasound can assess fetal hemodynamic status by measuring flows in the umbilical artery, ductus venosus, and middle cerebral artery. ↗
▶ Ep 23 · 1:43
clinical Fetal MRI contributes to diagnosis definition after ultrasound, especially for findings in the brain, chest, and abdomen. ↗
▶ Ep 23 · 1:43
clinical Fetal MRI contributes to diagnosis definition after ultrasound, especially for findings in the brain, chest, and abdomen. ↗
▶ Ep 23 · 2:04
quote So that's the goal of fetal intervention. Just try to rescue or improve these conditions. ↗
▶ Ep 23 · 2:04
quote So that's the goal of fetal intervention. Just try to rescue or improve these conditions. ↗
▶ Ep 23 · 2:13
clinical In gastroschisis, earlier delivery can reduce bowel injury, resulting in less serositis and better recovery. ↗
▶ Ep 23 · 2:13
clinical In gastroschisis, earlier delivery can reduce bowel injury, resulting in less serositis and better recovery. ↗
▶ Ep 23 · 2:29
quote Open fetal surgery is the most similar to neonatal surgery, so we have the patient in our hands. We can operate in a fetus the same as we operate in a preemie. ↗
▶ Ep 23 · 2:29
quote Open fetal surgery is the most similar to neonatal surgery, so we have the patient in our hands. We can operate in a fetus the same as we operate in a preemie. ↗
▶ Ep 23 · 2:37
quote The only problem is we need to open the uterus. ↗
▶ Ep 23 · 2:37
quote The only problem is we need to open the uterus. ↗
▶ Ep 23 · 3:01
quote For that reason, all the fetal surgeons were trying to go away from fetal surgery, trying to look for minimally invasive surgery. ↗
▶ Ep 23 · 3:01
quote For that reason, all the fetal surgeons were trying to go away from fetal surgery, trying to look for minimally invasive surgery. ↗
▶ Ep 23 · 3:12
quote Open fetal surgery still is used for large, solid masses in the chest, for sacrococcial teratomass, and also for spina bifida. ↗
▶ Ep 23 · 3:12
clinical Open fetal surgery is still used for large solid chest masses, sacrococcygeal teratomas, and spina bifida. ↗
▶ Ep 23 · 3:12
clinical Open fetal surgery is still used for large solid chest masses, sacrococcygeal teratomas, and spina bifida. ↗
▶ Ep 23 · 3:12
quote Open fetal surgery still is used for large, solid masses in the chest, for sacrococcial teratomass, and also for spina bifida. ↗
▶ Ep 23 · 3:30
clinical Solid CPAM lesions grow rapidly and can cause mediastinal shift, compression of the contralateral lung and heart, leading to hydrops fetalis. ↗
▶ Ep 23 · 3:30
clinical Solid CPAM lesions grow rapidly and can cause mediastinal shift, compression of the contralateral lung and heart, leading to hydrops fetalis. ↗
▶ Ep 23 · 3:49
clinical Hydrops fetalis (ascites, pleural effusion, scalp edema, anasarca) is very close to fetal demise and is the usual outcome if untreated. ↗
▶ Ep 23 · 3:49
clinical Hydrops fetalis (ascites, pleural effusion, scalp edema, anasarca) is very close to fetal demise and is the usual outcome if untreated. ↗
▶ Ep 23 · 3:57
quote So hydros fetalis is very close to be complete a fetal demise. That is the usual outcome of these babies if we don't do nothing. ↗
▶ Ep 23 · 3:57
quote So hydros fetalis is very close to be complete a fetal demise. That is the usual outcome of these babies if we don't do nothing. ↗
▶ Ep 23 · 4:25
quote Everything that measures less than 1.6 is very, very low risk of developed eye drops. On the contrary, more than 1.6, we have high risk of eye drops and complications. ↗
▶ Ep 23 · 4:25
clinical CVR less than 1.6 indicates very low risk of hydrops; CVR greater than 1.6 indicates high risk of hydrops and complications. ↗
▶ Ep 23 · 4:25
clinical CVR less than 1.6 indicates very low risk of hydrops; CVR greater than 1.6 indicates high risk of hydrops and complications. ↗
▶ Ep 23 · 4:25
quote Everything that measures less than 1.6 is very, very low risk of developed eye drops. On the contrary, more than 1.6, we have high risk of eye drops and complications. ↗
▶ Ep 23 · 4:53
quote It's a good rescue in more than half of these babies. So, the other half or 40%, probably don't respond very well. ↗
▶ Ep 23 · 4:53
epidemiological Steroids rescue more than half of CPAM cases; the remaining 40% do not respond well. ↗
▶ Ep 23 · 4:53
epidemiological Steroids rescue more than half of CPAM cases; the remaining 40% do not respond well. ↗
▶ Ep 23 · 4:53
quote It's a good rescue in more than half of these babies. So, the other half or 40%, probably don't respond very well. ↗
▶ Ep 23 · 5:01
clinical Before 30 weeks, cystic CPAM can be treated with a shunt; solid CPAM requires open fetal surgery and lobectomy. ↗
▶ Ep 23 · 5:01
clinical Before 30 weeks, cystic CPAM can be treated with a shunt; solid CPAM requires open fetal surgery and lobectomy. ↗
▶ Ep 23 · 5:22
clinical Solid sacrococcygeal teratomas are more dangerous than cystic ones due to rapid growth and vascularization visible on Doppler. ↗
▶ Ep 23 · 5:22
clinical Solid sacrococcygeal teratomas are more dangerous than cystic ones due to rapid growth and vascularization visible on Doppler. ↗
▶ Ep 23 · 5:32
clinical The Altman classification used postnatally can also be applied to prenatal MRI to determine teratoma type and need for intervention. ↗
▶ Ep 23 · 5:32
clinical The Altman classification used postnatally can also be applied to prenatal MRI to determine teratoma type and need for intervention. ↗
▶ Ep 23 · 5:51
guideline Open fetal surgery is the gold standard for spina bifida, though other innovations are in development. ↗
▶ Ep 23 · 5:51
guideline Open fetal surgery is the gold standard for spina bifida, though other innovations are in development. ↗
▶ Ep 23 · 6:04
clinical Spina bifida originates at approximately 4 weeks of embryonic time when the neural tube fails to close. ↗
▶ Ep 23 · 6:04
clinical Spina bifida originates at approximately 4 weeks of embryonic time when the neural tube fails to close. ↗
▶ Ep 23 · 6:16
clinical In spina bifida, the exposed spinal cord is damaged by contact with amniotic fluid rich in meconium and enzymes (the 'second hit'), progressively destroying neural tissue and nerves. ↗
▶ Ep 23 · 6:16
clinical In spina bifida, the exposed spinal cord is damaged by contact with amniotic fluid rich in meconium and enzymes (the 'second hit'), progressively destroying neural tissue and nerves. ↗
▶ Ep 23 · 7:28
clinical Hydrocephalus in spina bifida requires ventriculoperitoneal shunting and causes migration disorders and heterotopia. ↗
▶ Ep 23 · 7:28
clinical Hydrocephalus in spina bifida requires ventriculoperitoneal shunting and causes migration disorders and heterotopia. ↗
▶ Ep 23 · 7:51
clinical The rationale for fetal spina bifida repair is to prevent amniotic fluid from touching the nerves and to stop CSF leak. ↗
▶ Ep 23 · 7:51
clinical The rationale for fetal spina bifida repair is to prevent amniotic fluid from touching the nerves and to stop CSF leak. ↗
▶ Ep 23 · 8:34
clinical In fetoscopic spina bifida repair, a collagen patch is introduced through the cannula for duroplasty, maintained with one stitch, followed by primary skin closure or patch. ↗
▶ Ep 23 · 8:34
clinical In fetoscopic spina bifida repair, a collagen patch is introduced through the cannula for duroplasty, maintained with one stitch, followed by primary skin closure or patch. ↗
▶ Ep 23 · 8:58
clinical The EXIT procedure is performed at delivery for conditions that can cause neonatal asphyxia or difficult intubation, such as neck masses compressing the trachea, congenital airway obstruction, or severe micrognathia. ↗
▶ Ep 23 · 8:58
clinical The EXIT procedure is performed at delivery for conditions that can cause neonatal asphyxia or difficult intubation, such as neck masses compressing the trachea, congenital airway obstruction, or severe micrognathia. ↗
▶ Ep 23 · 9:25
clinical During EXIT, placental oxygenation can be maintained for 1 to 3 hours, providing a controlled situation without need to rush airway securement. ↗
▶ Ep 23 · 9:25
clinical During EXIT, placental oxygenation can be maintained for 1 to 3 hours, providing a controlled situation without need to rush airway securement. ↗
▶ Ep 23 · 9:48
clinical During EXIT for neck teratomas, if intubation is not possible with rigid instruments or laryngoscopy, partial resection of the teratoma can be performed to identify the trachea and then intubate. ↗
▶ Ep 23 · 9:48
clinical During EXIT for neck teratomas, if intubation is not possible with rigid instruments or laryngoscopy, partial resection of the teratoma can be performed to identify the trachea and then intubate. ↗
▶ Ep 23 · 10:10
clinical Once intubation is achieved during EXIT, the cord is clamped and complete teratoma resection is performed in an adjacent operating room. ↗
▶ Ep 23 · 10:10
clinical Once intubation is achieved during EXIT, the cord is clamped and complete teratoma resection is performed in an adjacent operating room. ↗
Jose's statements about Hydrocephalus 38 statements

Open the Hydrocephalus collection →

2024 Fetal Care Center Frontiers in Fetal Neurology Day 1 - Dr. Jose Peiro

▶ Ep 4 · 0:12
clinical 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. ↗
▶ Ep 4 · 1:00
clinical Aqueductal stenosis blocks normal CSF circulation, causing fluid buildup in lateral and third ventricles, representing a pure obstructive problem in fetuses and babies. ↗
▶ Ep 4 · 1:30
clinical 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. ↗
▶ Ep 4 · 2:00
clinical Ventriculomegaly and hydrocephalus can be detected very early in gestation using prenatal ultrasound, classified as mild, moderate, or severe. ↗
▶ Ep 4 · 2:20
clinical MRI is a very good tool to complete prenatal hydrocephalus evaluation and identify isolated aqueductal stenosis with genetic testing. ↗
▶ Ep 4 · 3:00
clinical Aqueductal stenosis is probably the most important cause of obstructive congenital hydrocephalus. ↗
▶ Ep 4 · 3:20
clinical Fetal hydrocephalus is associated with potentially poor outcomes including intellectual disabilities, spasticity, and seizures. ↗
▶ Ep 4 · 3:40
clinical Postnatal treatment of congenital hydrocephalus almost consistently requires CSF diversion, mostly with VP shunts, which have problems including malfunction and infection. ↗
▶ Ep 4 · 4:30
quote we know that any of these treatment postnatally probably arrives late because during the intrauterine period, uh there's a progressive brain deterioration ↗
▶ Ep 4 · 4:30
opinion Any postnatal treatment probably arrives late because progressive brain deterioration occurs during the intrauterine period, including denudation, astrocytosis, and microgliosis. ↗
▶ Ep 4 · 5:00
quote what about to do something before birth, right? Uh, as soon as possible just to stop this problem in the brain development. What about do a prenatal fetal ETV ↗
▶ Ep 4 · 6:00
clinical The first attempts at fetal hydrocephalus treatment were performed in fetal monkeys and chimp models using ventriculo-amniotic shunts approximately 40 years ago. ↗
▶ Ep 4 · 6:30
clinical The first human case of fetal hydrocephalus treatment was described by Birnholz, and 44 cases were collected in a registry and discussed at a 1982 fetal medicine and surgery meeting. ↗
▶ Ep 4 · 7:00
clinical Experts in fetal surgery decided on a moratorium on fetal hydrocephalus intervention after the 1982 meeting, likely due to suboptimal clinical outcomes and patient selection. ↗
▶ Ep 4 · 7:30
opinion Modern technology, better imaging, and genetic tools for patient selection make it sensible to reconsider fetal hydrocephalus treatment, specifically fetal ETV without hardware. ↗
▶ Ep 4 · 7:30
quote after 40 years, right, right now, and we have more technology, better imaging and genetic tools for better patient selection, so, it makes sense that possibility to recapitulate these uh treatments, but in my opinion, not to put any hardware, any, any shunt, just to try the ETB, make a hole and go ↗
▶ Ep 4 · 8:00
clinical In the fetal lamb model, kaolin injected into the cisterna magna creates moderate hydrocephalus but causes a meningitis-like irritation reaction. ↗
▶ Ep 4 · 8:40
quote we discovered that uh we can create in all the models. Uh, moderate hydrocephalus ↗
▶ Ep 4 · 9:00
quote we determined that uh analyzing all these groups in comparing Kaoline, Bioglue, and onyx, we decided uh that Bioglue was the best ↗
▶ Ep 4 · 9:00
clinical Comparing kaolin, bioglue, and onyx for creating fetal lamb hydrocephalus, bioglue was determined to be the best agent. ↗
▶ Ep 4 · 9:30
clinical A severity scale for fetal lamb hydrocephalus was developed with mild, moderate, and severe categories based on ventricular measurements. ↗
▶ Ep 4 · 10:00
clinical Only bioglue allowed creation of severe hydrocephalus cases in the fetal lamb model, with significant cortical thinning. ↗
▶ Ep 4 · 10:30
clinical The fetal lamb hydrocephalus model shows ependymal denudation with loss of cilia, likely due to ventricular distension. ↗
▶ Ep 4 · 11:00
clinical The percentage of ependymal denudation is higher with severe category hydrocephalus and occurs very early in gestation until delivery. ↗
▶ Ep 4 · 11:30
clinical Astrocytes replace ependymal cells and create scar tissue in areas of denudation. ↗
▶ Ep 4 · 11:50
clinical Activated microglia indicating neuroinflammation are present in areas of ependymal denudation, putting neuroprogenitor cells in the subventricular zone at risk of maldevelopment. ↗
▶ Ep 4 · 12:20
clinical Fetal ETV in the lamb model is performed using a 7 French rigid fetoscope or cystoscope inserted through the coronal suture approximately 1 centimeter to the midline to enter the lateral ventricle. ↗
▶ Ep 4 · 13:00
clinical The fetal lamb brain anatomy is more elongated than human, with a narrow foramen of Monro and other anatomical differences that create technical difficulties. ↗
▶ Ep 4 · 13:30
clinical In the fetal lamb model, the septum pellucidum is absent in hydrocephalus, allowing visualization of both lateral ventricles. ↗
▶ Ep 4 · 13:50
clinical The interthalamic adhesion in fetal lambs is very large, making the anatomy different from human. ↗
▶ Ep 4 · 14:10
clinical A rigid plastic fiber (laser without energy) is used to create a blunt opening in the third ventricle floor to avoid energy-related damage to the basilar artery in mid-gestation fetuses. ↗
▶ Ep 4 · 14:40
clinical Fetal ETV in the lamb model reduced ventricular size from severe to moderate-mild and from moderate to normal in most cases. ↗
▶ Ep 4 · 15:00
clinical A fetal surgeon in Brazil has performed percutaneous fetal ETV in 10 human cases with no deaths, demonstrating feasibility and safety. ↗
▶ Ep 4 · 15:10
clinical Fetal ETV improved cortical thickness (reduced compression) in treated fetal lambs. ↗
▶ Ep 4 · 15:30
quote We don't know if we prevent denudation or we are regenerating after recirculation and deflation of the ventricles, but we are working on that ↗
▶ Ep 4 · 15:30
clinical In most cases, fetal ETV recovered ependymal denudation, though it is unknown whether this represents prevention or regeneration after ventricular deflation. ↗
▶ Ep 4 · 15:40
quote I think we are ready just to start in USA ↗
▶ Ep 4 · 15:40
clinical A multi-center U.S. clinical trial is planned, starting with phase 1 in 10 human cases to assess safety and feasibility, followed by phase 2 in 50-60 cases to assess efficacy. ↗
Jose's statements about Pediatric Oncology 33 statements

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Open Fetal Surgery & EXIT Procedure with Dr. Jose Peiro

▶ Ep 532 · 0:33
quote The answer is very easy. It's just because we have prenatal diagnosis. ↗
▶ Ep 532 · 0:38
quote So in other words, we can detect things in utero very early in gestation. ↗
▶ Ep 532 · 0:47
quote The most important is the prenatal ultrasounds. The conventional ultrasounds at mid gestation around 20 weeks will be the best. ↗
▶ Ep 532 · 0:47
clinical Prenatal ultrasound at mid-gestation around 20 weeks is the best tool for detecting fetal malformations, with high detection rates in developed countries. ↗
▶ Ep 532 · 1:27
clinical Doppler ultrasound can assess fetal hemodynamic status by measuring flows in the umbilical artery, ductus venosus, and middle cerebral artery. ↗
▶ Ep 532 · 1:43
clinical Fetal MRI contributes to diagnosis definition after ultrasound, especially for findings in the brain, chest, and abdomen. ↗
▶ Ep 532 · 2:04
quote So that's the goal of fetal intervention. Just try to rescue or improve these conditions. ↗
▶ Ep 532 · 2:13
clinical In gastroschisis, earlier delivery can reduce bowel injury, resulting in less serositis and better recovery. ↗
▶ Ep 532 · 2:29
quote Open fetal surgery is the most similar to neonatal surgery, so we have the patient in our hands. We can operate in a fetus the same as we operate in a preemie. ↗
▶ Ep 532 · 2:37
quote The only problem is we need to open the uterus. ↗
▶ Ep 532 · 3:01
quote For that reason, all the fetal surgeons were trying to go away from fetal surgery, trying to look for minimally invasive surgery. ↗
▶ Ep 532 · 3:12
quote Open fetal surgery still is used for large, solid masses in the chest, for sacrococcial teratomass, and also for spina bifida. ↗
▶ Ep 532 · 3:12
clinical Open fetal surgery is still used for large solid chest masses, sacrococcygeal teratomas, and spina bifida. ↗
▶ Ep 532 · 3:30
clinical Solid CPAM lesions grow rapidly and can cause mediastinal shift, compression of the contralateral lung and heart, leading to hydrops fetalis. ↗
▶ Ep 532 · 3:49
clinical Hydrops fetalis (ascites, pleural effusion, scalp edema, anasarca) is very close to fetal demise and is the usual outcome if untreated. ↗
▶ Ep 532 · 3:57
quote So hydros fetalis is very close to be complete a fetal demise. That is the usual outcome of these babies if we don't do nothing. ↗
▶ Ep 532 · 4:25
clinical CVR less than 1.6 indicates very low risk of hydrops; CVR greater than 1.6 indicates high risk of hydrops and complications. ↗
▶ Ep 532 · 4:25
quote Everything that measures less than 1.6 is very, very low risk of developed eye drops. On the contrary, more than 1.6, we have high risk of eye drops and complications. ↗
▶ Ep 532 · 4:53
quote It's a good rescue in more than half of these babies. So, the other half or 40%, probably don't respond very well. ↗
▶ Ep 532 · 4:53
epidemiological Steroids rescue more than half of CPAM cases; the remaining 40% do not respond well. ↗
▶ Ep 532 · 5:01
clinical Before 30 weeks, cystic CPAM can be treated with a shunt; solid CPAM requires open fetal surgery and lobectomy. ↗
▶ Ep 532 · 5:22
clinical Solid sacrococcygeal teratomas are more dangerous than cystic ones due to rapid growth and vascularization visible on Doppler. ↗
▶ Ep 532 · 5:32
clinical The Altman classification used postnatally can also be applied to prenatal MRI to determine teratoma type and need for intervention. ↗
▶ Ep 532 · 5:51
guideline Open fetal surgery is the gold standard for spina bifida, though other innovations are in development. ↗
▶ Ep 532 · 6:04
clinical Spina bifida originates at approximately 4 weeks of embryonic time when the neural tube fails to close. ↗
▶ Ep 532 · 6:16
clinical In spina bifida, the exposed spinal cord is damaged by contact with amniotic fluid rich in meconium and enzymes (the 'second hit'), progressively destroying neural tissue and nerves. ↗
▶ Ep 532 · 7:28
clinical Hydrocephalus in spina bifida requires ventriculoperitoneal shunting and causes migration disorders and heterotopia. ↗
▶ Ep 532 · 7:51
clinical The rationale for fetal spina bifida repair is to prevent amniotic fluid from touching the nerves and to stop CSF leak. ↗
▶ Ep 532 · 8:34
clinical In fetoscopic spina bifida repair, a collagen patch is introduced through the cannula for duroplasty, maintained with one stitch, followed by primary skin closure or patch. ↗
▶ Ep 532 · 8:58
clinical The EXIT procedure is performed at delivery for conditions that can cause neonatal asphyxia or difficult intubation, such as neck masses compressing the trachea, congenital airway obstruction, or severe micrognathia. ↗
▶ Ep 532 · 9:25
clinical During EXIT, placental oxygenation can be maintained for 1 to 3 hours, providing a controlled situation without need to rush airway securement. ↗
▶ Ep 532 · 9:48
clinical During EXIT for neck teratomas, if intubation is not possible with rigid instruments or laryngoscopy, partial resection of the teratoma can be performed to identify the trachea and then intubate. ↗
▶ Ep 532 · 10:10
clinical Once intubation is achieved during EXIT, the cord is clamped and complete teratoma resection is performed in an adjacent operating room. ↗

Summaries Jose gave as host · 2 summaries

Recaps of what the experts said, with Jose as narrator — not Jose's own clinical position, and never cited in answers.

Summaries Jose gave as host · Aqueductal Stenosis 1 summary

Open the Aqueductal Stenosis collection →

2024 Fetal Care Center Frontiers in Fetal Neurology Day 1 - Dr. Jose Peiro

▶ Ep 3 · 4:10
host summary Jose Peiro summarizing a resource: Endoscopic third ventriculostomy can be performed postnatally to recirculate CSF as an alternative to shunting. ↗
Summaries Jose gave as host · Hydrocephalus 1 summary

Open the Hydrocephalus collection →

2024 Fetal Care Center Frontiers in Fetal Neurology Day 1 - Dr. Jose Peiro

▶ Ep 4 · 4:10
host summary Jose Peiro summarizing a resource: Endoscopic third ventriculostomy can be performed postnatally to recirculate CSF as an alternative to shunting. ↗