Preservation of Ovarian Germinal Follicles by Temporary Laparoscopic Ovarian Transposition in Teenaged Girls Undergoing Craniospinal Irradiation for Radiosensitive Central Nervous System Tumors

Abstract

Objective: To report the efficacy of laparoscopic ovarian transposition procedure in teenaged girls for preventing ovarian damage from craniospinal radiation therapy. Materials and Methods: Five teenaged girls were diagnosed with radiosensitive brain germinomas or medulloblastomas that needed irradiation with doses of higher than 500 cGy to the whole craniospinal area after craniotomy. The oophoropexy method was lateral transposition of the ovaries to the round ligament without opening the surrounding peritoneum so as to move the ovaries outside of the radiation field. Meanwhile, the hemoclip was clamped on the medial site of the ovary to guide the radiologist to set a proper field between the two ovaries for radiation therapy. After irradiation with the total dose completed, second-look laparoscopy was performed to remove the Prolene stitches and hemoclips. Bilateral ovarian biopsies were performed to evaluate the efficacy on the preservation of ovarian tissue, upon the consent of each patient and her parents. Results: On second-look laparoscopy, only small amounts of loose adhesions surrounding the hemoclips and ties were found. Histologic measurements showed that there were more than 10 germinal follicles per high-power field in each ovarian tissue section. Conclusion: Laparoscopic oophoropexy is an easy and safe surgical procedure for teenaged girls. It can be used to successfully prevent craniospinal irradiation damage to the ovarian germinal follicles in teenaged girls and to retain their ovarian reproductive function.

Keywords

• germinal follicle
• germinoma
• laparoscopy oophoropexy
• medulloblastoma
• ovarian transposition
• radiotherapy