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Authors: Vijay Mysore Ravindra, MD; Michael Belfort, MD, PhD; Magdelana Sanz Cortes, MD, PhD; Jimmy Espinoza, MD; Alireza Shamshirsaz, MD, PhD; Ahmed Nassr, MD; Olutoyin Olutoye; Oluyinka Olutoye, MD; William Whitehead (Salt Lake City, UT)

Introduction:

The use of fetoscopic techniques for closure of NTDs remains controversial. We describe a multi-layer technique and report immediate post-natal outcomes.

Methods:

Using a two-port (12F) technique with a CO2 insufflated, exteriorized uterus, repair of the NTD is undertaken. The placode is untethered and a patch graft is placed over the placode. The skin, and frequently a dura-fascial flap is created on either side of the canal; these layers are closed using simple interrupted sutures. Procedure and immediate clinical variables were collected and analyzed.

Results:


Twelve patients with open NTD’s underwent surgery from July 2017 to March 2018. The mean gestational age at surgery was 25 weeks (range 24 – 25). The mean surgical time was 243 minutes (range 163-298); mean NTD closure was 141 minutes (range 87-211). Two patients experienced preterm premature rupture of membranes at <37 weeks, one <34 weeks.  The median gestational age at delivery was 38.8 weeks (range 31.1-40.8). 70% of infants were delivered vaginally. There were no cases of uterine dehiscence. Three infants delivered at <37 weeks, none before 30 weeks. In utero reversal of hindbrain herniation occurred in 90% of cases. There were no post-natal CSF leaks and no additional dehiscence repairs. One patient has required treatment for hydrocephalus (shunt) at a median follow-up of 4.3 months . 80% of children afforded improvement in one or more functional level/anatomic level at birth.

Conclusions:

This fetoscopic multi-layer closure of myelomeningocele is feasible and has similar neurological outcomes to open hysterotomy fetal repair. Further longitudinal studies are planned.

American Academy of Pediatrics Award