Open Fetal Microneurosurgery for Intrauterine Spina Bifida Repair

Area of Science:

• Fetal surgery
• Maternal-fetal medicine
• Pediatric neurosurgery

Background:

• Spina bifida (SB) is a complex congenital condition requiring surgical intervention.
• Traditional open fetal surgery for SB has been associated with significant maternal and fetal risks.
• Minimally invasive techniques are being explored to improve outcomes in fetal surgery.

Purpose of the Study:

• To evaluate the feasibility of open fetal microneurosurgery for intrauterine spina bifida repair.
• To compare perinatal outcomes between open microneurosurgery and classic open fetal surgery.
• To assess the safety and efficacy of a novel minimally invasive approach for fetal SB repair.

Main Methods:

• A cohort of fetuses with isolated open SB underwent intrauterine repair between 2016-2020.
• Two techniques were compared: classic open surgery (large hysterotomy) and open microneurosurgery (small hysterotomy, reduced manipulation).
• Perinatal outcomes including gestational age at intervention and birth, rates of complications, and perinatal death were analyzed.

Main Results:

• Open microneurosurgery was successfully performed in 47 cases, compared to 13 with classic open surgery.
• Microneurosurgery group showed significantly lower rates of oligohydramnios (0% vs. 15.4%) and preterm rupture of membranes (19.0% vs. 53.8%).
• Higher gestational age at birth (35.1 vs. 32.7 weeks), reduced preterm delivery <34 weeks (21.4% vs. 61.5%), and lower perinatal death rates (4.8% vs. 23.1%) were observed with microneurosurgery.

Conclusions:

• Open fetal microneurosurgery is a feasible technique for intrauterine spina bifida repair.
• Microneurosurgery is associated with significantly better perinatal outcomes compared to classic open fetal surgery.
• The novel approach offers a promising alternative for managing spina bifida in utero.