Fetoscopy Techniques for Myelomeningocele

Myelomeningocele (MMC) repair was traditionally performed postpartum. Developmental delay, neurological deficits, and the need for shunting are persistent problems associated with this type of repair. Alternative open prenatal repairs have been proposed. Clinical studies suggest improved short-term neurological outcomes with percutaneous minimally invasive and intrauterine fetoscopic techniques using endoscopes, when compared with an open prenatal or postnatal repair. In this chapter, the authors present the various currently practiced forms of percutaneous fetoscopic MMC repair. These are frequently carried out via externalization of the uterus through a maternal laparotomy. The primary limitations of these procedures are preterm premature rupture of membranes (PPROM) and dehiscence or leakage at the MMC repair. The authors also present their preferred three-layer repair technique and their clinical outcomes of a small case series performed to date. Their results suggest several benefits of the full percutaneous fetoscopic technique, including a lower risk of preterm labor, reduced need for postnatal revisions, and improved newborn maturity with higher gestational age. The authors conclude that fetoscopy may also offer better management of the membranes and primary closure of uterine port sites. The long-term cognitive, behavioral, and functional outcomes of fetoscopic MMC repair will need to be studied. Additional clinical outcome studies should show whether caesarean section may be required for delivery in subsequent pregnancies following the use of the fetoscopic technique to avoid uterine rupture that is commonplace after traditional open prenatal MMC repair. With the authors' technique, spontaneous vaginal delivery at term is feasible.

Keywords: Developmental delay, Intrauterine fetoscopic techniques, Myelomeningocele, Neurological deficits, Postpartum.