title: Fetoscopic versus Open Repair for Spina Bifida Aperta: A Systematic Review of Outcomes.
abstract: OBJECTIVE
  To compare outcomes of fetoscopic spina bifida aperta repair (FSBAR) with the results of the open approach (OSBAR) as in the Management Of Myelomeningocele Study (MOMS).
  
  
  METHODS
  This was a systematic comparison of reports on FSBAR with data from the MOMS (n = 78). Inclusion criteria were studies of spina bifida aperta patients who underwent FSBAR and were followed for ≥12 months. Primary outcome was perinatal mortality. Secondary outcomes included operative, maternal, fetal, neonatal and infant outcomes.
  
  
  RESULTS
  Out of 16 reports, we included 5 from 2 centers. Due to bias and heterogeneity, analysis was restricted to two overlapping case series (n = 51 and 71). In those, FSBAR was technically different from OSBAR, had comparable perinatal mortality (7.8 vs. 2.6%, p = 0.212) and shunt rate at 12 months (45 vs. 40%, p = 0.619), longer operation time (223 vs. 105 min, p < 0.001), higher preterm prelabor membrane rupture rate (84 vs. 46%, p < 0.001), earlier gestational age at birth (32.9 vs. 34.1 weeks, p = 0.03), higher postnatal reoperation rate (28 vs. 2.56%, p < 0.001) and absence of uterine thinning or dehiscence (0 vs. 36%, p < 0.001). Functional outcomes were not available.
  
  
  CONCLUSIONS
  FSBAR utilizes a different neurosurgical technique, takes longer to complete, induces more prematurity, requires additional postnatal procedures, yet has a comparable shunt rate and is not associated with uterine thinning or dehiscence. Long-term functional data are awaited.
authors.affiliation: Academic Department of Development and Regeneration, Cluster Organ Systems, Biomedical Sciences, Faculty of Medicine, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Joyeux
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Engels
authors.forename: Francesca M
authors.initials: FM
authors.lastname: Russo
authors.forename: Julio
authors.initials: J
authors.lastname: Jimenez
authors.forename: Tim
authors.initials: T
authors.lastname: Van Mieghem
authors.forename: Paolo
authors.initials: P
authors.lastname: De Coppi
authors.forename: Frank
authors.initials: F
authors.lastname: Van Calenbergh
authors.forename: Jan
authors.initials: J
authors.lastname: Deprest
mesh_terms: D000328:Adult; D005260:Female; D005332:Fetoscopy / Q000009:adverse effects / Q000379:methods*; D005333:Fetus / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D066087:Perinatal Death; D011247:Pregnancy; D012086:Reoperation; D018570:Risk Assessment; D016135:Spinal Dysraphism / Q000601:surgery*; D016896:Treatment Outcome