Acta Neurochirurgica

, Volume 160, Issue 8, pp 1625–1631 | Cite as

Homologous cryopreserved amniotic membrane in the repair of myelomeningocele: preliminary experience

  • Elisabetta Marton
  • Enrico GiordanEmail author
  • Giorgio Gioffrè
  • Giuseppe Canova
  • Adolfo Paolin
  • Marina Grazia Mazzucco
  • Pierluigi Longatti
Original Article - Pediatric Neurosurgery



Surgical management of spinal dysraphism often requires the use of dural substitutes. Amniotic membrane (AM) has drawn the interest of clinicians for its valuable concentration of cytokines and factors capable of promoting wound healing, re-epithelialization, inhibiting fibrosis and regulating angiogenesis. These beneficial qualities could make AM an interesting dural substitute for spina bifida repair. In this study, we describe the use of banked homologous AM as a dural substitute for the repair of spinal dysraphism in newborns. Our purpose is to test the mechanical characteristics, as well as the safety and effectiveness of AM in preventing postoperative complications and re-tethering.


The AM patch was carefully detached from the chorion of donors undergoing caesarean section, rinsed in saline solution, and cryopreserved in liquid nitrogen. Five newborns were treated using AM: three affected by open spinal dysraphism and two by spina bifida occulta. The AM patch was used as a dural substitute with two different positions and purposes: the amnion-side down covering the placode to prevent adhesions or placed extradurally facing the dura to avoid scarring and facilitating the sliding of the dural sac itself under the extradural tissue layers.


No adverse events occurred, and the surgical wounds healed without complications. MRI scans taken at 3 and 6 months after surgery showed a satisfying de-tethering of the spinal cord with no obvious evidence of new adherence formation.


We present a multimodal interposition technique using AM as a reconstructive and anti-adhesive tissue for the treatment of open myelomeningocele (MMC) and lipomeningocele (LMC) treatment. In our experience, AM proved its efficacy in restoring the dural sac integrity without complications. We support the use of AM as a promising dural substitute, speculating on how the use of AM could potentially change reconstructive strategies for spinal dysraphism.


Myelomeningocele repair Amniotic membrane Spina bifida treatment Myelomeningocele surgery Spinal cord tethering Homologous amniotic membrane 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained for the procedure illustrated. However, no IRB approval is required per institutional policy for retrospective, single-cases in which no identifiable patient information is shared.


  1. 1.
    dR A (1940) Plastic repair of conjunctival defects with fetal membrane. Arch Ophthalmol 23:522–525CrossRefGoogle Scholar
  2. 2.
    Adzick NS, Thom EA, Spong CY, Brock JW 3rd, Burrows PK, Johnson MP, Howell LJ, Farrell JA, Dabrowiak ME, Sutton LN, Gupta N, Tulipan NB, D'Alton ME, Farmer DL (2011) A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 364:993–1004. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Branski LK, Herndon DN, Celis MM, Norbury WB, Masters OE, Jeschke MG (2008) Amnion in the treatment of pediatric partial-thickness facial burns. Burns 34:393–399. CrossRefPubMedGoogle Scholar
  4. 4.
    Brown EG, Saadai P, Pivetti CD, Beattie MS, Bresnahan JC, Wang A, Farmer DL (2014) In utero repair of myelomeningocele with autologous amniotic membrane in the fetal lamb model. J Pediatr Surg 49:133–137; discussion 137-138. CrossRefPubMedGoogle Scholar
  5. 5.
    Carvalho NS, Moron AF, Menon R, Cavalheiro S, Barbosa MM, Milani HJ, Ishigai MM (2017) Histological evidence of reparative activity in chorioamniotic membrane following open fetal surgery for myelomeningocele. Exp Ther Med 14:3732–3736. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    de Weerd L, Weum S, Sjavik K, Acharya G, Hennig RO (2013) A new approach in the repair of a myelomeningocele using amnion and a sensate perforator flap. J Plast Reconstr Aesthet Surg : JPRAS 66:860–863. CrossRefPubMedGoogle Scholar
  7. 7.
    Gajiwala K, Lobo Gajiwala A (2003) Use of banked tissue in plastic surgery. Cell Tissue Bank 4:141–146. CrossRefPubMedGoogle Scholar
  8. 8.
    Grivell RM, Andersen C, Dodd JM (2014) Prenatal versus postnatal repair procedures for spina bifida for improving infant and maternal outcomes. Cochrane Database Syst Rev : Cd008825. doi:
  9. 9.
    Gurer B, Kertmen H, Akturk UD, Kalan M, Sekerci Z (2014) Use of the bovine pericardial patch and fibrin sealant in meningomyelocele closure. Acta Neurochir 156:1345–1350. CrossRefPubMedGoogle Scholar
  10. 10.
    Hasegawa M, Fujisawa H, Hayashi Y, Yamashita J (2004) Autologous amnion graft for repair of myelomeningocele: technical note and clinical implication. J Clin Neurosci : Off J Neurosurg Soc Aust 11:408–411. CrossRefGoogle Scholar
  11. 11.
    Insausti CL, Alcaraz A, Garcia-Vizcaino EM, Mrowiec A, Lopez-Martinez MC, Blanquer M, Pinero A, Majado MJ, Moraleda JM, Castellanos G, Nicolas FJ (2010) Amniotic membrane induces epithelialization in massive posttraumatic wounds. Wound Repair Regen 18:368–377. CrossRefPubMedGoogle Scholar
  12. 12.
    Koizumi NJ, Inatomi TJ, Sotozono CJ, Fullwood NJ, Quantock AJ, Kinoshita S (2000) Growth factor mRNA and protein in preserved human amniotic membrane. Curr Eye Res 20:173–177CrossRefPubMedGoogle Scholar
  13. 13.
    Lien SC, Maher CO, Garton HJ, Kasten SJ, Muraszko KM, Buchman SR (2010) Local and regional flap closure in myelomeningocele repair: a 15-year review. Childs Nerv Syst 26:1091–1095. CrossRefPubMedGoogle Scholar
  14. 14.
    Liu J, Sheha H, Fu Y, Liang L, Tseng SC (2010) Update on amniotic membrane transplantation. Expert Rev Ophthalmol 5:645–661. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Mamede AC, Carvalho MJ, Abrantes AM, Laranjo M, Maia CJ, Botelho MF (2012) Amniotic membrane: from structure and functions to clinical applications. Cell Tissue Res 349:447–458. CrossRefPubMedGoogle Scholar
  16. 16.
    Ozcelik D, Yildiz KH, Is M, Dosoglu M (2005) Soft tissue closure and plastic surgical aspects of large dorsal myelomeningocele defects (review of techniques). Neurosurg Rev 28:218–225. CrossRefPubMedGoogle Scholar
  17. 17.
    Paolin A, Trojan D, Leonardi A, Mellone S, Volpe A, Orlandi A, Cogliati E (2016) Cytokine expression and ultrastructural alterations in fresh-frozen, freeze-dried and gamma-irradiated human amniotic membranes. Cell Tissue Bank 17:399–406. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Patel KB, Taghinia AH, Proctor MR, Warf BC, Greene AK (2012) Extradural myelomeningocele reconstruction using local turnover fascial flaps and midline linear skin closure. J Plast Reconstr Aesthet Surg 65:1569–1572. CrossRefPubMedGoogle Scholar
  19. 19.
    Pedreira DA, Zanon N, Nishikuni K, Moreira de Sa RA, Acacio GL, Chmait RH, Kontopoulos EV, Quintero RA (2016) Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial. Am J Obstet Gynecol 214:111.e111. CrossRefGoogle Scholar
  20. 20.
    Saad H, Krisht KM, Yang WH, Lopez-Gonzalez MA, Aboud E, Krisht AF (2017) Biocompatible amniotic sac implant maintains a scar-free brain surface during recurrent glioma surgery. World Neurosurg 107:308–313. CrossRefPubMedGoogle Scholar
  21. 21.
    Solomon A, Pires RT, Tseng SC (2001) Amniotic membrane transplantation after extensive removal of primary and recurrent pterygia. Ophthalmology 108:449–460CrossRefPubMedGoogle Scholar
  22. 22.
    Sridhar MS, Bansal AK, Sangwan VS, Rao GN (2000) Amniotic membrane transplantation in acute chemical and thermal injury. Am J Ophthalmol 130:134–137CrossRefPubMedGoogle Scholar
  23. 23.
    Tao H, Fan H (2009) Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions. Eur Spine J 18:1202–1212. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Tomita T, Hayashi N, Okabe M, Yoshida T, Hamada H, Endo S, Nikaido T (2012) New dried human amniotic membrane is useful as a substitute for dural repair after skull base surgery. J Neurol Surg B Skull Base 73:302–307. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Tseng SC, Espana EM, Kawakita T, Di Pascuale MA, Li W, He H, Liu TS, Cho TH, Gao YY, Yeh LK, Liu CY (2004) How does amniotic membrane work? Ocul Surf 2:177–187CrossRefPubMedGoogle Scholar
  26. 26.
    Tulipan N, Wellons JC 3rd, Thom EA, Gupta N, Sutton LN, Burrows PK, Farmer D, Walsh W, Johnson MP, Rand L, Tolivaisa S, D'Alton ME, Adzick NS (2015) Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement. J Neurosurg Pediatr 16:613–620. CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Turchan A, Rochman TF, Ibrahim A, Fauziah D, Wahyuhadi J, Parenrengi MA, Fauzi AA, Sufarnap E, Bajamal AH, Ferdiansyah SH, Purwati RFA, Paramadini AW, Lumenta CB (2018) Duraplasty using amniotic membrane versus temporal muscle fascia: a clinical comparative study. J Clin Neurosci 50:272–276. CrossRefPubMedGoogle Scholar
  28. 28.
    Walker CT, Godzik J, Kakarla UK, Turner JD, Whiting AC, Nakaji P (2018) Human amniotic membrane for the prevention of intradural spinal cord adhesions: retrospective review of its novel use in a case series of 14 patients. Neurosurgery.
  29. 29.
    Zohar Y, Talmi YP, Finkelstein Y, Shvili Y, Sadov R, Laurian N (1987) Use of human amniotic membrane in otolaryngologic practice. Laryngoscope 97:978–980PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery, Treviso HospitalUniversity of PadovaPadovaItaly
  2. 2.Treviso Tissue Bank FoundationPadovaItaly

Personalised recommendations