In utero repair of myelomeningocele: A comparison of endoscopy and hysterotomy

Objective: To compare endoscopic coverage of myelomeningocele with a matern al 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-thicknes s skin graft in a CO2 environment at 22-24 weeks' gestation, Subsequently, 4 fetuses underwent standard neurosurgical closure of their myelomeningocel es at 28-29 weeks' gestation. Results: The mean operating time for the endo scopic procedures was 297 +/- 69 min. Two fetal losses occurred as a result of chorioamnionitis and placental abruption, respectively. A third baby de livered at 28 weeks' gestation after prolonged disruption of the membranes. The 2 survivors required standard closure of the myelomeningocele after de livery. 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 functiona l levels of all infants approximate the anatomical levels of the lesions. C onclusion: With current technology, in utero repair of congenital myelomeni ngocele through a hysterotomy appears to be technically superior to procedu res performed endoscopically, Copyright (C) 2000 S. Karger AG, Basel.