Fetoscopic correction of myelomeningocele

Prenatal surgery of myelomeningocele reduces the frequency of ventriculoperitoneal shunting and improves the development of the nervous system of the neonate after birth. The hysterotomy necessary to perform open surgery on a fetus with a spinal defect is associated with a risk of uterine rupture in subsequent pregnancies and premature births. A rupture at the site of the hysterotomy gives a significant risk of mortality and adverse outcomes for the mother and fetus. It is possible that in the near future, in some cases, the role of open fetal surgery in the treatment of spina bifida may be limited. Currently, the first reports of fetoscopicplastу of myelomeningocele have appeared, which have demonstrated that this approach is accompanied by the same neurological outcomes in newborns as after using open surgical approach. Fetoscopy can be performed using two approaches: 1) on the open uterus using maternal laparotomy or 2) percutaneous maternal access. An approach based on laparotomy leads to a reduction in premature rupture of the amniotic membranes and an increase in the gestational age of labor in comparison with percutaneous access. However, the transdermal approach is constantly being modified and its results continue to improve. The endosurgical methods that are used to repair a spinal defect are not yet standardized and the method of plasty can affect long-term results, especially in relation to a neurogenic bladder and a fixed spinal cord. It is possible that in the near future, in some cases, the role of open fetal surgery in the treatment of spinal hernia may be limited. This literature review presents the results of the known reports on fetoscopic correction of myelomeningocele. We presented the details and tricks of the technology of these impressive and completely new for pediatric surgeons operations.