Myelomeningocele (MMC) repair was traditionally performed postpartum.
Developmental delay, neurological deficits, and the need for shunting are persistent
problems associated with this type of repair. Alternative open prenatal repairs have
been proposed. Clinical studies suggest improved short-term neurological outcomes
with percutaneous minimally invasive and intrauterine fetoscopic techniques using
endoscopes, when compared with an open prenatal or postnatal repair. In this chapter,
the authors present the various currently practiced forms of percutaneous fetoscopic
MMC repair. These are frequently carried out via externalization of the uterus through
a maternal laparotomy. The primary limitations of these procedures are preterm
premature rupture of membranes (PPROM) and dehiscence or leakage at the MMC
repair. The authors also present their preferred three-layer repair technique and their
clinical outcomes of a small case series performed to date. Their results suggest several
benefits of the full percutaneous fetoscopic technique, including a lower risk of preterm labor, reduced need for postnatal revisions, and improved newborn maturity with
higher gestational age. The authors conclude that fetoscopy may also offer better
management of the membranes and primary closure of uterine port sites. The long-term
cognitive, behavioral, and functional outcomes of fetoscopic MMC repair will need to
be studied. Additional clinical outcome studies should show whether caesarean section
may be required for delivery in subsequent pregnancies following the use of the
fetoscopic technique to avoid uterine rupture that is commonplace after traditional open
prenatal MMC repair. With the authors' technique, spontaneous vaginal delivery at
term is feasible.
Keywords: Developmental delay, Intrauterine fetoscopic techniques, Myelomeningocele, Neurological deficits, Postpartum.
