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)
The use of fetoscopic techniques for closure of NTD’s remains controversial. We describe a multi-layer technique and report immediate post-natal outcomes.
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.
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.
This fetoscopic multi-layer closure of myelomeningocele is feasible and has similar neurological outcomes to open hysterotomy fetal repair. Further longitudinal studies are planned.