Fetoscopic Repair of Meningomyelocele

BACKGROUND: Currently, maternal-fetal surgery for repair of myelomeningocele requires an upper-segment hysterotomy, which likely increases maternal postsurgical risks. If fetoscopic repair of myelomeningocele achieves similar or better fetal outcomes while decreasing maternal risks, it would be a better option. CASE: A patient with a fetus with a L3-S1 meningomyelocele underwent a laparotomy and fetoscopic repair using a two-port, in-CO2 approach at 23 2/7 weeks of gestation. The neonate was delivered at 30 6/7 weeks of gestation by lower segment cesarean delivery and required no further surgery, has not needed a shunt (5 months), and has normal, age-appropriate neurologic function. CONCLUSION: This innovative fetoscopic approach may offer an alternative to open fetal surgery and may prevent the need for hysterotomy and cesarean delivery in index and subsequent pregnancies.