Fetoscopic Repair of Meningomyelocele
Michael A Belfort1, William E Whitehead, Alireza A Shamshirsaz
1Baylor College of Medicine, Departments of Obstetrics and Gynecology, Neurosurgery, and Surgery, Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.
Background:
Currently, maternal-fetal surgery for repair of myelomeningocele requires an upper-segment hysterotomy, which likely increases maternal postsurgical risks. If fetoscopic repair of myelomeningocele achieves similar or better fetal outcomes while decreasing maternal risks, it would be a better option.
Case:
A patient with a fetus with a L3-S1 meningomyelocele underwent a laparotomy and fetoscopic repair using a two-port, in-CO2 approach at 23 2/7 weeks of gestation. The neonate was delivered at 30 6/7 weeks of gestation by lower segment cesarean delivery and required no further surgery, has not needed a shunt (5 months), and has normal, age-appropriate neurologic function.
Conclusion:
This innovative fetoscopic approach may offer an alternative to open fetal surgery and may prevent the need for hysterotomy and cesarean delivery in index and subsequent pregnancies.
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