Advances in Fetal Surgical Repair of Open Spina Bifida

Abstract

Spina bifida remains a common congenital anomaly of the central nervous system despite national fortification of foods with folic acid, with a prevalence of 2-4 per 10,000 live births. Prenatal screening for the early detection of this condition provides patients with the opportunity to consider various management options during pregnancy. Prenatal repair of open spina bifida, traditionally performed by the open maternal-fetal surgical approach through hysterotomy, has been shown to improve outcomes for the child, including decreased need for cerebrospinal fluid diversion surgery and improved lower neuromotor function. However, the open maternal-fetal surgical approach is associated with relatively increased risk for the patient and the overall pregnancy, as well as future pregnancies. Recent advances in minimally invasive prenatal repair of open spina bifida through fetoscopy have shown similar benefits for the child but relatively improved outcomes for the pregnant patient and future childbearing.

Implementation and Assessment of a Laparotomy-Assisted Three-Port Fetoscopic Spina Bifida Repair Program

“…Other reasons are less manipulation of the membranes and uterine environment due to the precise placement of the ports directly on the uterus and the gentle hand-held positioning of the fetus. However, these laparoscopic techniques have undergone several modifications making comparison of outcomes difficult [16][17][18][19].…”

Fetal in-utero management of myelomeningocele: a mini-review on history, challenges, management gap, and recommendations

“…The guidelines for fetal MMC repair emphasize a multidisciplinary team approach, extensive prenatal evaluation using fetal MRI, precise surgical technique, and close postoperative monitoring 19 . Furthermore, it is suggested to provide all evidence-based treatment choices, such as antenatal or fetal closure, pregnancy termination, and adoption, with early consultation taking place between weeks 18 and 20 of gestation 20 . The surgical and obstetrical consequences should be carefully considered, and genetic testing by amniocentesis is recommended to guide decision-making about in-utero MMC closure.…”