Outcomes Following Fetoscopic Repair of Myelomeningocele: A Prospective Single-Center Experience
Vincent Duron1, Russell Miller2, Neil Feldstein3
1Division of Pediatric Surgery, Department of Surgery, Columbia University Irving Medical Center / NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA.
Objective:
Prenatal repair of myelomeningocele (MMC) improves fetal outcomes; however, open uterine surgery has associated morbidities. We report our institutional outcomes following laparotomy-assisted fetoscopic MMC repair.
Methods:
A prospective observational study, including a 1-year follow-up period, was conducted from April 2018 to March 2024. Similar study considerations from the 2011 Management of Myelomeningocele Study (MOMS) and 2019 MOMS Plus study were applied. Laparotomy-assisted repair utilized an extended Pfannenstiel incision and vertical midline fascial incision to exteriorize the uterus for trocar placement. Primary outcomes were ventriculoperitoneal (VP) shunt at 12 months or perinatal death. Secondary outcomes included select maternal and neonatal outcomes.
Results:
Of 39 qualifying patients, 10 underwent repair at a median GA of 25w4d (IQR 25w0d-26w6d). All pregnancies resulted in live births in a median GA of 36w1d (IQR 32w2d-37w0d). Preterm premature rupture of membranes was observed (PPROM) in five patients. Four patients delivered vaginally without complications. All trocar sites were noted to be intact at the time of cesarean deliveries. Two neonates required revision of MMC closure after birth. One patient required a VP shunt placement at 4 months of age.
Conclusion:
Early results at our center demonstrate that laparotomy-assisted fetoscopic MMC repair is a safe option for qualified patients.
