{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:59:02Z","timestamp":1785387542109,"version":"3.55.0"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T00:00:00Z","timestamp":1631491200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>A trial comparing prenatal with postnatal open spina bifida (OSB) repair established that prenatal surgery was associated with better postnatal outcome. However, in the trial, fetal surgery was carried out through hysterotomy. Minimally invasive approaches are being developed to mitigate the risks of open maternal\u2013fetal surgery. The objective of this study was to investigate the impact of a novel neurosurgical technique for percutaneous fetoscopic repair of fetal OSB, the skin\u2010over\u2010biocellulose for antenatal fetoscopic repair (SAFER) technique, on long\u2010term postnatal outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study examined descriptive data for all patients undergoing fetoscopic OSB repair who had available 12\u2010 and 30\u2010month follow\u2010up data for assessment of need for cerebrospinal fluid (CSF) diversion and need for bladder catheterization and ambulation, respectively, from eight centers that perform prenatal OSB repair via percutaneous fetoscopy using a biocellulose patch between the neural placode and skin\/myofascial flap, without suture of the dura mater (SAFER technique). Univariate and multivariate logistic regression analyses were used to examine the effect of different factors on need for CSF diversion at 12\u2009months and ambulation and need for bladder catheterization at 30\u2009months. Potential cofactors included gestational age at fetal surgery and delivery, preoperative ultrasound findings of anatomical level of the lesion, cerebral lateral ventricular diameter, lesion type and presence of bilateral talipes, as well as postnatal findings of CSF leakage at birth, motor level, presence of bilateral talipes and reversal of hindbrain herniation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 170 consecutive patients with fetal OSB were treated prenatally using the SAFER technique. Among these, 103 babies had follow\u2010up at 12\u2009months of age and 59 had follow\u2010up at 30\u2009months of age. At 12\u2009months of age, 53.4% (55\/103) of babies did not require ventriculoperitoneal shunt or third ventriculostomy. At 30\u2009months of age, 54.2% (32\/59) of children were ambulating independently and 61.0% (36\/59) did not require chronic intermittent catheterization of the bladder. Multivariate logistic regression analysis demonstrated that significant prediction of need for CSF diversion was provided by lateral ventricular size and type of lesion (myeloschisis). Significant predictors of ambulatory status were prenatal bilateral talipes and anatomical and functional motor levels of the lesion. There were no significant predictors of need for bladder catheterization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Children who underwent prenatal OSB repair via the percutaneous fetoscopic SAFER technique achieved long\u2010term neurological outcomes similar to those reported in the literature after hysterotomy\u2010assisted OSB repair. \u00a9 2021 The Authors. Ultrasound in Obstetrics &amp; Gynecology published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23658","type":"journal-article","created":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T20:59:48Z","timestamp":1619038788000},"page":"582-589","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Percutaneous fetoscopic spina bifida repair: effect on ambulation and need for postnatal cerebrospinal fluid diversion and bladder catheterization"],"prefix":"10.1002","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3150-9187","authenticated-orcid":false,"given":"D. A.","family":"Lapa","sequence":"first","affiliation":[{"name":"Fetal Therapy Team Coordinator Hospital Infantil Sabara  S\u00e3o Paulo Brazil"},{"name":"Fetal Therapy Group Hospital Israelita Albert Einstein  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. H.","family":"Chmait","sequence":"additional","affiliation":[{"name":"Los Angeles Fetal Surgery, Department of Obstetrics and Gynecology Keck School of Medicine, University of Southern California  Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Gielchinsky","sequence":"additional","affiliation":[{"name":"Fetal Therapy, Helen Schneider Hospital for Women Rabin Medical Center  Petah Tikva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Clinica Universidad Los Andes  Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Persico","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health University of Milan  Milan Italy"},{"name":"Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Santorum","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. M.","family":"Gil","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Hospital Universitario de Torrej\u00f3n  Madrid Spain"},{"name":"School of Medicine Universidad Francisco de Vitoria  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Trigo","sequence":"additional","affiliation":[{"name":"Fetal Therapy Group Hospital Israelita Albert Einstein  S\u00e3o Paulo Brazil"},{"name":"BCNatal Fetal Medicine Research Center  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. A.","family":"Quintero","sequence":"additional","affiliation":[{"name":"The Fetal Institute  Miami FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. 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