Endoscopic fetal surgery for neural tube defects.

Prenatal repair of open spina bifida reduces shunt rates and may improve postnatal motor and neurodevelopmental outcomes. The hysterotomy required for the open fetal surgery leaves subsequent pregnancies at risk of uterine rupture. Hysterotomy site rupture confers significant morbidity and mortality risks for both mother and fetus. Fetoscopic repair is feasible and seems to achieve at least the same, postnatal neurological outcomes as those of the open repair. Fetoscopy can be accomplished by a laparotomy-based approach, or it can be entirely percutaneous. Thus far, the laparotomy-based approach leads to less PPROM and higher gestational age of delivery than the percutaneous-based one. However, the percutaneous approach is being modified, and outcomes are continuing improving, now delivery reached 35 weeks. Surgical techniques for the repair of the defect are not yet standardized, and the type of defect repair may affect long-term outcomes, especially regarding neurogenic bladder and cord tethering. The role of open fetal surgery in the management of spina bifida may be restricted to selected cases in the near future.