{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T03:05:58Z","timestamp":1793675158901,"version":"4.5.1"},"reference-count":45,"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>The objective of this study was to describe the technical aspects and postnatal neurosurgical outcomes of a prenatal, 3-miniport fetoscopic myelomeningocele (MMC) repair technique providing a multilayered closure using cryopreserved decellularized human umbilical cord (HUC) matrix allograft for duraplasty.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors conducted a subanalysis of an ongoing prospective cohort study analyzing the neurosurgical outcomes of 57 of 92 consecutive patients who underwent multilayered fetoscopic surgical MMC repair using HUC matrix allograft for duraplasty at their institution from December 2016 to March 2022, including more than 24 months of postnatal follow-up.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Of 92 patients who underwent fetoscopic MMC repair, 88 had duraplasty using cryopreserved HUC matrix allograft. Fifty-seven patients had at least 24 months of follow-up data. The mean gestational age at the time of surgical repair was 24.8 \u00b1 0.7 weeks. The average operative time from skin incision to closure was 260 \u00b1 43.4 minutes, in which 79% of this time was used for the fetoscopic portion. No patient required intraoperative emergency delivery. At birth, there were no cases of CSF leak or complete wound dehiscence. Six (11.5%) of 52 patients experienced superficial wound dehiscence, and only 2 (3.5%) required surgical revision. At 30 months, 54.8% of patients were noted to be independent ambulators, 35.5% were therapeutic ambulators, and 9.7% remained wheelchair users in this subset of patients. The rate of hydrocephalus requiring CSF diversion was 35.3%, and 84.3% of patients had complete reversal of hindbrain herniation at birth. Eight (15.7%) of 51 patients had spinal inclusion cysts noted on routine follow-up spinal imaging, but only 2 (3.9%) required surgical intervention due to radiological progression without neurological symptoms.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>A laparotomy-assisted, 3-miniport fetoscopic approach for prenatal MMC multilayered repair offers excellent access and visualization for an effective watertight closure. The use of HUC matrix allograft as a dural substitute was shown to be effective with a low rate of neurosurgical postnatal complications.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.8.peds2488","type":"journal-article","created":{"date-parts":[[2024,11,9]],"date-time":"2024-11-09T02:29:55Z","timestamp":1731119395000},"page":"1-9","source":"Crossref","is-referenced-by-count":9,"title":["Cryopreserved decellularized human umbilical cord matrix allograft as duraplasty for fetoscopic prenatal spina bifida repair"],"prefix":"10.3171","author":[{"given":"Amanda","family":"Kwasnicki","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurosurgery, Cincinnati Children\u2019s Hospital Medical Center (CCHMC), Cincinnati;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles B.","family":"Stevenson","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Fetal Care Center,"},{"name":"Division of Pediatric Neurosurgery, Cincinnati Children\u2019s Hospital Medical Center (CCHMC), Cincinnati;"},{"name":"University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Braxton","family":"Forde","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Fetal Care Center,"},{"name":"Division of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati; and"},{"name":"University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mounira","family":"Habli","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Fetal Care Center,"},{"name":"Division of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati;"},{"name":"University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"McKinney","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Fetal Care Center,"},{"name":"Division of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati; and"},{"name":"University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erinn","family":"Goetz","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Fetal Care Center,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Foong-Yen","family":"Lim","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Fetal Care Center,"},{"name":"Division of Pediatric General and Thoracic Surgery, and"},{"name":"University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose L.","family":"Peiro","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Fetal Care Center,"},{"name":"Division of Pediatric General and Thoracic Surgery, and"},{"name":"University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"PLoS One","first-page":"e0151586","article-title":"Describing the prevalence of neural tube defects worldwide: a systematic literature review","volume":"11","author":"Zaganjor I","year":"2016","unstructured":"Zaganjor I, Sekkarie A, Tsang BL,  Describing the prevalence of neural tube defects worldwide: a systematic literature review. 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