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


CONCLUSIONS
With current technology, in utero repair of congenital myelomeningocele through a hysterotomy appears to be technically superior to procedures performed endoscopically.
Bruner
J P
JP
Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tenn., USA. joe.bruner@mcmail.vanderbilt.edu
Tulipan
N B
NB
Richards
W O
WO
Walsh
W F
WF
Boehm
F H
FH
Vrabcak
E K
EK
D000328:Adult; D004724:Endoscopy; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D020883:Hysterotomy; D008591:Meningomyelocele / Q000601:surgery*; D011247:Pregnancy; D013997:Time Factors; D016896:Treatment Outcome