Minimal invasive fetoscopic closure of myelomeningocele – postoperative care and interdisciplinary disease-management

Introduction: A new developed minimal invasive fetoscopic procedure to cover open spinal dysraphias seems to be successful and has been implemented by studies for some years. Tissue should be saved from chemical and mechanic irritation. Furthermore a beneficial effect on development of Arnold-Chiari-malformation is supposed (less spinal liquor loss).

Preterm births are a common consecution of that surgical intervention. There are marginal risks for the mother. Authors suggest a definite surgical care of open spinal defects soon after birth.

Case report: We report on a boy presentated first time at the age of 3 months with sacral myelomeningocele and normal neurological situation except for a mild disturbed bladder function. In agreement with parents and neurosurgeons we decided for waiting by looking after neurological criteria and MRI of brain and spine periodical.

With mild Arnold-Chiari-Malformation he developed a hydrocephalus at the age of 12 months and needed a ventriculoperitoneal shunt surgery. At the age of 9 months the parents remarked a sudden deterioration of bladder function without motor or sensory failures. Diagnostic investigations showed the tethering at sacral lesion an a large locular syringohydromyelia, the patch was inserted in the neural placode, a dermoid had developed. Postoperative course showed no neurological deterioration or other problems.

Conclusion: We agree to other authors, that definite closure of spina bifida aperta should be implemented early after birth, even in intact neurological function and normal development. Covering the cerebrospinal fluid leakage with a patch during pregnancy does not reliably prevent Arnold-Chiari-malformation or hydrocephalus. We look forward to the results of current studies on fetoscopic covering of open spinal dysraphias.

In our opinion, in sacral palsy level a good long-term-outcome may be achieved also by conventional treatment as prognosis is excellent with regard to motoric function development.

spina bifida aperta-fetoscopic closure-tethered cord-hydrocephalus-long term outcome