Totally Percutaneous Fetoscopic Repair of Open Spina Bifida: A Single-Center Experience with Perinatal, Obstetric,...

Objectives: To evaluate perinatal, obstetric, and early functional outcomes following totally percutaneous fetoscopic repair of open spina bifida (OSB) using the skin-over-biocellulose for antenatal fetoscopic repair (SAFER) technique. Methods: This retrospective cohort study included all fetuses who underwent totally percutaneous fetoscopic repair of OSB at a single tertiary referral center between September 2018 and March 2026. Eligibility was based on predefined clinical criteria. Data on maternal, fetal, operative, and neonatal outcomes were collected. The primary outcomes included perinatal and obstetric results, need for cerebrospinal fluid (CSF) diversion within the first year of life, and early functional outcomes, including motor improvement and ambulation. Exploratory analyses were performed to assess associations between procedural factors and obstetric outcomes. Results: Twenty-two fetuses underwent fetoscopic repair. The procedure was completed in 95% of cases. Median gestational age at surgery was 28.2 weeks. Preterm prelabor rupture of membranes (PPROM) occurred in 68% of cases, and the median gestational age at delivery was 32.7 weeks. All fetuses were live-born, with no neonatal deaths. Maternal outcomes were favorable, with no maternal mortality and no ICU admissions. Vaginal delivery was achieved in 50% of cases, with no uterine rupture or dehiscence. The rate of CSF diversion within the first year was 31.8%. Reversal of hindbrain herniation was observed in 95% of cases. A motor improvement of ≥2 levels was achieved in 68% of patients, with no cases of functional deterioration. Community ambulation at ≥24 months was observed in 53% of cases with available follow-up. Conclusions: Totally percutaneous fetoscopic repair of OSB using the SAFER technique was associated with favorable perinatal, obstetric, and early functional outcomes in this single-center cohort. The high incidence of PPROM and subsequent preterm delivery remains an obstetrical challenge. Maternal safety profile, including the preservation of uterine integrity for vaginal delivery, and the early neurological benefits were encouraging. Our results support the feasibility of this approach and highlight the absolute necessity of multidisciplinary expertise and structured training.