Fully Percutaneous Fetoscopic Repair of Myelomeningocele: 30-Month Follow-up Data

The 2011 Management of Myelomeningocele Study (MOMS) reported improved postnatal outcomes for fetuses with myelomeningocele (MMC) who underwent intrauterine repair by open surgery, via hysterectomy, compared with those who underwent traditional postnatal surgery. The study found that the need for shunt decreased by 50% in children who underwent intrauterine repair. Recent 30-month outcome data from MOMS also found that children who underwent intrauterine repair showed improvements in the ability to walk independently and the level of paraparesis. Advances in technology have opened the door to the use of a less invasive treatment for MMC with percutaneous fetoscopic fetal surgery. Yet evidence supporting this is lacking. This study reports on postnatal outcomes of children who underwent fetoscopic repair of MMC. This was an observational study of 72 children who underwent percutaneous fetoscopic repair of MMC from October 2010 to August 2014 at University Hospital of Giessen, Germany. A total of 52 children were included in the study cohort, and 50 children completed the 30-month study protocol. The study protocol required them to visit the clinic 4 times-shortly after birth and at 3, 12, and 30 months of age. During the visit, neurological tests appropriate for their age and assessments of their leg movement and ambulation were examined. The Bayley Scales of Infant Development, second edition (BSID-II), were performed at 30 months only to assess the children's mental and motor development. The mortality rate among the 72 children who survived fetoscopic MMC repair was 5.6% (n = 4 deaths). Of the 52 children in the cohort, 11.5% were born before 30 weeks' gestation (mean gestational age at delivery, 33 + 1 weeks). A total of 22 children (46%) needed shunt placement within 12 months after birth. At 30 months, there were 46 children (92%) with a BSID-II mental development index (MDI) >= 50, 40 children (80%) with a normal MDI >= 70, and 36 children (72%) with an MDI >= 85. There were 37 children (74%) with a psychomotor development index (PDI) >= 50, 35 children (70%) with normal PDI >= 70, and 22 children (44%) with PDI >= 85. In 23 children (46%), their functional lesion level was >= 2 segments better than anatomically expected. In 17 children (34%), there functional level was 1 segment better. Also at 30 months, 23 children (46%) could walk independently without orthotics, 19 (38%) could walk with orthotics or other devices, and the remaining 8 (16%) could not walk unaided. In conclusion, postnatal outcomes in children who underwent fetoscopic MMC repair were similar to the outcomes observed in those who underwent open intrauterine repair. Improvements at 30 months were observed in the rates of mortality, prematurity, and shunt placement, as well as mental and motor development.