In utero repair of myelomeningocele: a comparison of endoscopy and hysterotomy

Abstract

Objective: To compare endoscopic coverage of myelomeningocele with a maternal split-thickness skin graft in utero to definitive neurosurgical closure through a hysterotomy.

Methods: Four fetuses with isolated myelomeningocele underwent endoscopic coverage of the defect with a maternal split-thickness skin graft in a CO(2) environment at 22-24 weeks' gestation. Subsequently, 4 fetuses underwent standard neurosurgical closure of their myelomeningoceles at 28-29 weeks' gestation.

Results: The mean operating time for the endoscopic procedures was 297 +/- 69 min. Two fetal losses occurred as a result of chorioamnionitis and placental abruption, respectively. A third baby delivered at 28 weeks' gestation after prolonged disruption of the membranes. The 2 survivors required standard closure of the myelomeningocele after delivery. The mean operating time for the hysterotomy procedures was 125 +/- 8 min. No mortality occurred, and all the infants delivered between 33 and 36 weeks with well-healed myelomeningocele scars. At present, the functional levels of all infants approximate the anatomical levels of the lesions.

Conclusion: With current technology, in utero repair of congenital myelomeningocele through a hysterotomy appears to be technically superior to procedures performed endoscopically.