{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T11:55:40Z","timestamp":1775390140755,"version":"3.50.1"},"reference-count":55,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare prenatal and postnatal brain microstructure between infants that underwent fetoscopic myelomeningocele (MMC) repair and those that had open\u2010hysterotomy repair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a longitudinal retrospective cohort study of 57 fetuses that met the Management of Myelomeningocele Study (MOMS) trial criteria and underwent prenatal MMC repair, by a fetoscopic (<jats:italic>n<\/jats:italic>\u2009=\u200927) or open\u2010hysterotomy (<jats:italic>n<\/jats:italic>\u2009=\u200930) approach, at 21.4\u201325.9\u2009weeks' gestation. Fetoscopic repair was performed under CO<jats:sub>2<\/jats:sub> insufflation, according to our protocol. Diffusion\u2010weighted magnetic resonance imaging (MRI)   was performed before surgery in 30 cases (14 fetoscopic and 16 open), at 6\u2009weeks postsurgery in 48 cases (24 fetoscopic and 24 open) and within the first year after birth in 23 infants (five fetoscopic and 18 open). Apparent diffusion coefficient (ADC) values from the basal ganglia, frontal, occipital and parietal lobes, mesencephalon and genu as well as splenium of the corpus callosum were calculated. ADC values at each of the three timepoints (presurgery, 6\u2009weeks postsurgery and postnatally) and the percentage change in the ADC values between the timepoints were compared between the fetoscopic\u2010repair and open\u2010repair groups. ADC values at 6\u2009weeks after surgery in the two prenatally repaired groups were compared with those in a control group of eight healthy fetuses that underwent MRI at a similar gestational age (GA). Comparison of ADC values was performed using the Student's <jats:italic>t<\/jats:italic>\u2010test for independent samples (or Mann\u2013Whitney <jats:italic>U<\/jats:italic>\u2010test if non\u2010normally distributed) and multivariate general linear model analysis, adjusting for GA or age at MRI and mean ventricular width.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were no differences in GA at surgery or GA\/postnatal age at MRI between the groups. No significant differences were observed in ADC values in any of the brain areas assessed between the open\u2010repair and fetoscopic\u2010repair groups at 6\u2009weeks after surgery and in the first year after birth. No differences were detected in the ADC values of the studied areas between the control and prenatally repaired groups, except for significantly increased ADC values in the genu of the corpus callosum in the open\u2010hysterotomy and fetoscopic\u2010repair groups. Additionally, there were no differences between the two prenatally repaired groups in the percentage change in ADC values at any of the time intervals analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Fetoscopic MMC repair has no detectable effect on brain microstructure when compared to babies repaired using an open\u2010hysterotomy technique. CO<jats:sub>2<\/jats:sub> insufflation of the uterine cavity during fetoscopy does not seem to have any isolated deleterious effects on fetal brain microstructure. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.20373","type":"journal-article","created":{"date-parts":[[2019,6,20]],"date-time":"2019-06-20T15:44:41Z","timestamp":1561045481000},"page":"87-95","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy\u2010assisted fetoscopic or open approach"],"prefix":"10.1002","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0265-9859","authenticated-orcid":false,"given":"M.","family":"Sanz Cortes","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2010Fetal Medicine, Baylor College of Medicine Texas Children's Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Torres","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2010Fetal Medicine, Baylor College of Medicine Texas Children's Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Yepez","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2010Fetal Medicine, Baylor College of Medicine Texas Children's Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Guimaraes","sequence":"additional","affiliation":[{"name":"Department of Radiology, Baylor College of Medicine Texas Children's Hospital  Houston TX USA"},{"name":"Department of Radiology Lucile Packard Children's Hospital, Stanford University  Palo Alto CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Zarutskie","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2010Fetal Medicine, Baylor College of Medicine Texas Children's Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Shetty","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2010Fetal Medicine, Baylor College of Medicine Texas Children's Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2010Fetal Medicine, Baylor College of Medicine Texas Children's Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Pyarali","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2010Fetal Medicine, Baylor College of Medicine Texas Children's Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I.","family":"Davila","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2010Fetal Medicine, Baylor College of Medicine Texas Children's Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9830-2212","authenticated-orcid":false,"given":"J.","family":"Espinoza","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2010Fetal Medicine, Baylor College of Medicine Texas Children's Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. 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