Safety and Effectiveness of Fetal Myelomeningocele Repair: Case Series Analysis Using an Exteriorized Uterus and a Fetoscopic Approach.

Introduction: This study evaluated the surgical details and outcomes of fetal myelomeningocele (MMC) repair using a minimally invasive fetoscopic approach with uterine exposure.

Methods: This retrospective case series study examines consecutive fetuses who underwent fetoscopic spina bifida repair performed by a single team. The pregnant women's demographic data, surgical technical aspects, complications, and neonatal surgical outcomes were analyzed.

Results: From 2019 to 2022, 32 fetuses underwent the fetoscopic repair of MMC at an average gestational age of 25.2 ± 0.9 weeks (range 23.2-26.6). Dura mater collagen substitutes were used for duraplasty in all cases, and in three, an additional myofascial flap was used. There were no significant maternal complications. Overall perinatal complication rate was 18% (6/32), including a perinatal mortality rate of 12.5% (4/32) and two cases of skin suture dehiscence. No cases of cerebrospinal fluid (CSF) leakage were observed. The mean gestational age at birth was 34.6 ± 3.6 weeks, and 31% of deliveries were vaginal. Among the 28 neonates followed for at least 12 months, and only 14% required CSF diversion.

Conclusion: Exteriorized uterus fetoscopic repair of MMC proved safe for the mother and effective in closing the neural tube defect. It also reduced the necessity for CSF diversion and preserved uterine function for future pregnancies. These findings endorse the potential of minimally invasive techniques in fetal MMC repair.