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Neurodevelopmental Outcomes after Fetoscopic Myelomeningocele Repair
Romain Corroenne1, Sabrina Rangwani1, William E Whitehead2
1Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Baylor College of Medicine & Texas Children's Hospital, Houston, TX.
Insights
Fetoscopic myelomeningocele repair shows promising neurodevelopmental outcomes, with over two-thirds of infants achieving normal scores by 18 months. These results are comparable to open fetal surgery and superior to postnatal repair.
Area of Science:
- Pediatric Surgery
- Neurodevelopmental Pediatrics
- Fetal Medicine
Background:
- Myelomeningocele repair aims to improve neurodevelopmental outcomes.
- Prenatal surgical interventions, including fetoscopic and open fetal surgery, have been developed to address myelomeningocele.
- Comparing outcomes across different repair methods is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate neurodevelopmental outcomes in infants following fetoscopic myelomeningocele repair.
- To compare these outcomes with those of infants who underwent open hysterotomy repair or postnatal repair.
Main Methods:
- A cohort of 132 infants (93 prenatal, 39 postnatal) was studied.
- Neurodevelopmental assessments (Capute scales, Developmental Profile 3) were conducted at or beyond 18 months.
- Outcomes were compared between fetoscopic, open fetal, and postnatal repair groups, adjusting for age and hydrocephalus treatment.
Main Results:
- Fetoscopic repair showed normal Clinical Linguistic & Auditory Milestone Scale (CLAMS) in 75.8% and normal Clinical Adaptive Test (CAT) in 69.7% of cases.
- Neurodevelopmental outcomes after fetoscopic repair were similar to open fetal surgery repair.
- Fetoscopic repair group had significantly better CLAMS and CAT scores compared to the postnatal repair group.
Conclusions:
- Laparotomy-assisted fetoscopic myelomeningocele repair leads to normal neurodevelopmental outcomes in approximately two-thirds of cases at 18 months.
- Fetoscopic repair offers comparable neurodevelopmental results to open fetal surgery.
- Fetoscopic repair demonstrates superior neurodevelopmental outcomes compared to postnatal repair.
Objectives:
To report the neurodevelopmental outcomes after a fetoscopic myelomeningocele repair and to compare them with children who had an open hysterotomy repair or a postnatal repair.
Study Design:
We included 132 infants (prenatal repair, 93 [69 fetoscopic and 24 open hysterotomy]; postnatal repair, 39). Neurodevelopmental outcomes at or beyond 18 months were evaluated by a developmental pediatrician using the Capute scales (Clinical Adaptive Test [CAT]/Clinical Linguistic & Auditory Milestone Scale [CLAMS]) and/or during parental interview using Developmental Profile 3 test. Scores were examined against reference values at each gestational age. A normal score was defined as ≥70%. Neurodevelopmental scores were compared while adjusting for infants' age at the time of testing and the need for hydrocephalus treatment.
Results:
After a fetoscopic repair, normal CLAMS results were observed in 25 of 33 cases (75.8%) and normal CAT in 23 of 33 (69.7%); the Developmental Profile 3 showed normal social-emotional scores in 60 of 65 (92.3%), normal cognition in 55 of 65 (84.6%), normal communication in 51 of 65 (78.5%), normal adaptive behavior in 48 of 65 (73.8%), normal general development in 39 of 65(60%), and normal physical score in 31 of 65 (47.7%) of the cases. Children who underwent a fetoscopic repair had similar neurodevelopmental outcomes compared with those who had an open fetal surgery repair. There was a significantly higher proportion of children with a normal CLAMS (25/33 [75.8%] vs 12/39 [30.8%], P < .01) and normal CAT (23/33 [69.7%] vs 16/39 [41.0%], P = .04) in the fetoscopic group compared with the postnatal repair group.
Conclusions:
Children who undergo laparotomy-assisted fetoscopic myelomeningocele repair present with normal neurodevelopmental outcomes in two-thirds of the cases included in this study at ≥ 18 months of age and had similar neurodevelopmental outcomes as those who had an open fetal surgery repair.
