Endoscopic fetal surgery for neural tube defects

Area of Science:

• Medical Science
• Surgical Innovation
• Fetal Medicine

Background:

• Open fetal surgery for spina bifida improves outcomes but necessitates a hysterotomy, risking uterine rupture in subsequent pregnancies.
• Uterine rupture from hysterotomy poses severe risks to both mother and fetus.

Purpose of the Study:

• To evaluate the feasibility and outcomes of fetoscopic repair of open spina bifida.
• To compare fetoscopic techniques (laparotomy-based vs. percutaneous) with open fetal surgery.

Main Methods:

• Fetoscopic repair of open spina bifida.
• Comparison of laparotomy-based versus percutaneous fetoscopic approaches.
• Assessment of postnatal motor and neurodevelopmental outcomes, shunt rates, and gestational age at delivery.

Main Results:

• Fetoscopic repair is feasible and achieves comparable postnatal neurological outcomes to open repair.
• Laparotomy-based fetoscopy currently offers lower rates of preterm premature rupture of membranes (PPROM) and higher gestational age at delivery than percutaneous methods.
• Ongoing modifications to the percutaneous approach are improving outcomes, with deliveries now reaching 35 weeks.

Conclusions:

• Fetoscopic repair of spina bifida is a viable alternative to open surgery, potentially reducing risks to future pregnancies.
• Standardization of surgical techniques is needed to optimize long-term outcomes, including neurogenic bladder and cord tethering.
• Open fetal surgery may become limited to select cases as fetoscopic techniques advance.