{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T21:56:49Z","timestamp":1793051809178,"version":"4.5.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>This study reports the infant to preschool outcomes of a laparotomy-assisted, two-port fetoscopic myelomeningocele (MMC) repair and compares the results with those of a contemporary, same-center cohort that underwent either fetal MMC surgery via hysterotomy or postnatal MMC repair.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>All MMC closures between December 2011 and July 2021 were screened. Singleton pregnancies with hindbrain herniation and MMC between T1 and S1 were included. Fetuses were excluded for genetic abnormalities, severe kyphosis, and other congenital anomalies. The pregnant woman determined the method of MMC repair (fetoscopic, hysterotomy, or postnatal repair).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Two hundred MMC closures met the study criteria (100 fetoscopic, 41 hysterotomy, and 59 postnatal). The median length of follow-up was beyond 46 months for all groups. The median gestational age at delivery was 38.1 weeks (IQR 35.1, 39.1 weeks) for the fetoscopic group, 35.7 weeks (IQR 33.6, 37.0 weeks) for the hysterotomy group, and 38.6 weeks (IQR 37.7, 39.0 weeks) for the postnatal group. Vaginal delivery occurred in 51% of the fetoscopic cases, and there were no instances of uterine dehiscence or rupture. Treatment for hydrocephalus in the 1st year occurred in 35% (95% CI 27%\u201350%) of fetoscopic, 33% (95% CI 20%\u201350%) of hysterotomy, and 81% (95% CI 70%\u201390%) of postnatal repair cases. At 30 months, patients who underwent fetal intervention were twice as likely to be community ambulators (with or without devices) as those who underwent postnatal repair (52% [95% CI 42%\u201362%] of fetoscopic, 54% [95% CI 39%\u201368%] of hysterotomy, and 24% [95% CI 14%\u201336%] of postnatal cases). Surgery for symptomatic tethered cord occurred in 12% (95% CI 7%\u201319%) of fetoscopic, 17% (95% CI 8%\u201331%) of hysterotomy, and 2% (95% CI 1%\u20138%) of postnatal repair cases. Surgery for symptomatic spinal inclusion cysts was required in 4% (95% CI 1%\u20139%) of fetoscopic, 7% (95% CI 2%\u201318%) of hysterotomy, and none (95% CI 0%\u20138%) of the postnatal cases.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Laparotomy-assisted, two-port fetoscopic repair provides significant benefits for maternal health. It negates the risk of uterine rupture for the index pregnancy and subsequent pregnancies and allows for vaginal delivery. The benefits to the fetus are the same as those of hysterotomy repairs, with a lower risk of prematurity. There was no difference in the rate of surgery for tethered cord or spinal inclusion cysts between fetoscopic and hysterotomy procedures. Overall, laparotomy-assisted, two-port fetoscopic repair is safer for the fetus and the mother than fetal MMC surgery via hysterotomy.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.7.peds24200","type":"journal-article","created":{"date-parts":[[2024,11,2]],"date-time":"2024-11-02T02:29:38Z","timestamp":1730514578000},"page":"1-12","source":"Crossref","is-referenced-by-count":14,"title":["Laparotomy-assisted, two-port fetoscopic myelomeningocele repair: infant to preschool outcomes"],"prefix":"10.3171","author":[{"given":"Magdalena","family":"Sanz-Cortes","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children\u2019s Hospital Pavilion for Women, Houston, Texas;"},{"name":"Texas Children\u2019s Fetal Center, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William E.","family":"Whitehead","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children\u2019s Hospital Pavilion for Women, Houston, Texas;"},{"name":"Department of Neurosurgery, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca M.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children\u2019s Hospital Pavilion for Women, Houston, Texas;"},{"name":"Texas Children\u2019s Fetal Center, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Aldave","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Castillo","sequence":"additional","affiliation":[{"name":"Division of Developmental Medicine, Department of Pediatrics, Children\u2019s Nebraska, Omaha, Nebraska;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilesh K.","family":"Desai","sequence":"additional","affiliation":[{"name":"Edward B. Singleton Department of Radiology, Texas Children\u2019s Hospital, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roopali","family":"Donepudi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children\u2019s Hospital Pavilion for Women, Houston, Texas;"},{"name":"Department of Neurosurgery, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc","family":"Joyeux","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Fetal Center, Houston, Texas;"},{"name":"Division of Pediatric Surgery, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"King","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Fetal Center, Houston, Texas;"},{"name":"Division of Pediatric Surgery, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen F.","family":"Kralik","sequence":"additional","affiliation":[{"name":"Edward B. Singleton Department of Radiology, Texas Children\u2019s Hospital, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Lepard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, Texas;"},{"name":"Department of Neurosurgery, Children\u2019s Healthcare of Atlanta, Emory University, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G.","family":"Mann","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, Texas;"},{"name":"Department of Pediatric Anesthesiology, Perioperative, and Pain Medicine, Division of Maternal-Fetal Anesthesia, Texas Children\u2019s Hospital, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel G.","family":"McClugage","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Fetal Center, Houston, Texas;"},{"name":"Department of Neurosurgery, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed A.","family":"Nassr","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children\u2019s Hospital Pavilion for Women, Houston, Texas;"},{"name":"Texas Children\u2019s Fetal Center, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Naus","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Fetal Center, Houston, Texas;"},{"name":"Department of Pediatric Anesthesiology, Perioperative, and Pain Medicine, Division of Maternal-Fetal Anesthesia, Texas Children\u2019s Hospital, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Castillo","sequence":"additional","affiliation":[{"name":"Division of Developmental Medicine, Department of Pediatrics, Children\u2019s Nebraska, Omaha, Nebraska;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay M.","family":"Ravindra","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, Texas;"},{"name":"Naval Medical Center San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin D.","family":"Sutton","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Fetal Center, Houston, Texas;"},{"name":"Department of Pediatric Anesthesiology, Perioperative, and Pain Medicine, Division of Maternal-Fetal Anesthesia, Texas Children\u2019s Hospital, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard L.","family":"Weiner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Belfort","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children\u2019s Hospital Pavilion for Women, Houston, Texas;"},{"name":"Department of Neurosurgery, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"J Neurosurg Pediatr","first-page":"613","article-title":"Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement","volume":"16","author":"Tulipan N","year":"2015","unstructured":"Tulipan N, Wellons JC III, Thom EA,  Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement. 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Am J Obstet Gynecol. 2019;220(5):494.e1\u2013494.e7."},{"issue":"5","key":"b4","series-title":"Ultrasound Obstet Gynecol","first-page":"515","article-title":"Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta. Part I: surgical technique and perioperative outcome","volume":"44","author":"Kohl T","year":"2014","unstructured":"Kohl T. Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta. Part I: surgical technique and perioperative outcome. Ultrasound Obstet Gynecol. 2014;44(5):515\u2013524."},{"issue":"1","key":"b5","series-title":"Am J Obstet Gynecol","first-page":"111.e1","article-title":"Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial","volume":"214","author":"Pedreira DA","year":"2016","unstructured":"Pedreira DA, Zanon N, Nishikuni K,  Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial. 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Fetal Diagn Ther. 2020;47(2):115\u2013122."},{"issue":"1","key":"b13","series-title":"Pediatr Neurosurg","first-page":"52","article-title":"Use of bipedicular advancement flaps for intrauterine closure of myeloschisis","volume":"32","author":"Mangels KJ","year":"2000","unstructured":"Mangels KJ, Tulipan N, Bruner JP, Nickolaus D. Use of bipedicular advancement flaps for intrauterine closure of myeloschisis. Pediatr Neurosurg. 2000;32(1):52\u201356."},{"issue":"1","key":"b14","series-title":"Ultrasound Obstet Gynecol","first-page":"81","article-title":"Neuroprotection is improved by watertightness of fetal spina bifida repair in the sheep model","volume":"61","author":"Joyeux L","year":"2023","unstructured":"Joyeux L, van der Merwe J, Aertsen M,  Neuroprotection is improved by watertightness of fetal spina bifida repair in the sheep model. 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