Open fetal surgery for spina bifida in a tertiary hospital in Argentina: short- and medium-term outcomes.

Abstract

Introduction. Spina bifida, particularly its most common form, myelomeningocele (MMC), is a severe congenital malformation associated with high neonatal morbidity and long-term disability. Since 2015, our center has been performing intrauterine repair of MMC using a modified open surgical technique. Objective. To describe the obstetric and perinatal outcomes, the need for treatment of hydrocephalus, and the ability to walk in children who underwent open fetal surgery for repair of spinal dysraphism, and to compare these data with those published in the Management of Myelomeningocele Study (MOMS). Population and methods. Retrospective observational study of 102 consecutive cases operated on between 2015 and 2023. Maternal, neonatal, and neurological variables were analyzed in the mediumterm follow-up. Results. The mean gestational age at the time of surgery was 26.1 weeks. Maternal and neonatal complication rates were similar to or lower than those reported in the MOMS study. The need for ventriculoperitoneal shunting at 12 months was 23.8%. At 30 months, 84.8% of patients were walking with or without orthopedic devices. Conclusion. Open fetal repair of MMC at our center, performed by a multidisciplinary team using a modified surgical technique, presented a favorable maternal-fetal safety profile. The perinatal and neurological outcomes obtained are comparable to those of international reference centers, with a low rate of ventriculoperitoneal shunting and a high percentage of children able to walk at 30 months of age. These findings support the continuation and optimization of this intervention in experienced centers.