Intrauterine total percutaneous fetoscopic repair of myelomeningocele: 30 months follow up data.

BACKGROUND Open intrauterine MMC repair has been proven to result in a significant improvement of long term milestones like shunt placement rates as well as motor and mental development, when compared to postnatal surgery. A fetoscopic approach offers reduced invasiveness, a lower risk of uterine rupture, and the option of vaginal delivery. OBJECTIVES This observational study reports on postnatal mortality and 30 months outcome of children who underwent total intrauterine percutaneous fetoscopic repair of their MMC in Giessen. METHODS During October 2010 and August 2014 a total of 72 mother-child dyads received intrauterine fetoscopic MMC closure. Of these 72, 52 (72%) participated in this study. However, 30 months mortality data are available for all 72 children. We examined children at four time-points: 1) shortly after birth, 2) at 3 months, 3) at 12 months, and 4) at 30 months of corrected age. Thirty months follow up data are now presented for 50 patients who underwent fetoscopic intrauterine MMC repair. RESULTS 72 children received intrauterine total fetoscopic surgery between 21+0 and 29+1weeks (mean 23+5). All children survived the intrauterine procedure, however 4 (5.5%) infants died postnatally. 11.7% of children were delivered before the 30th week of gestation (mean 33+1 weeks). In 48.14% of the children VP shunt placement was performed. Independent ambulation, without orthosis, at 30 months was feasible for 46% of children. At 30 months of follow up 46% of children presented with a functional level that was 2 or more segments better than their anatomical level. 70% of the children presented with Bayley Scales II psychomotor score (PDI) of ≥70. Assessment of cognitive development by the Bayley Scales II (MDI) again showed a test score of ≥70 for 80% of children at 30 months. CONCLUSION Controlled head to head comparisons of open vs. fetoscopic intrauterine repair investigating long term outcome are lacking. However, concerning mortality, prematurity, shunt placement rates, motor and mental development, and free ambulation, intrauterine repair by percutaneous fetoscopy results in an outcome that seems to lie in range with results reported for open intrauterine repair. This article is protected by copyright. All rights reserved.