Fetal Surgery Techniques for Neural Tube Defects
Summary
Neural tube defects represent common congenital malformations arising from incomplete closure of the neural tube in early gestation. Fetal surgery for open spina bifida, or myelomeningocele, has evolved from pioneering open hysterotomy approaches to more refined minimally invasive methods. In an open procedure, maternal laparotomy and uterine incision allow direct repair of the exposed spinal cord, which has been shown to improve hindbrain position, reduce the need for ventriculoperitoneal shunting and preserve motor and bladder function. Fetoscopic techniques employ small uterine ports and endoscopic instruments to minimise maternal morbidity and the risk of preterm birth. Hybrid approaches combine limited hysterotomy with endoscopic closure using biomaterials or biocellulose patches. Timing of intervention, typically between 19 and 26 weeks’ gestation, is critical to balance neurodevelopmental benefit against maternal and obstetric risks. Advances in imaging guidance, surgical planning and tissue engineering continue to extend the safety, efficacy and global applicability of in utero repair for neural tube defects.
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Fetal Surgery Techniques for Neural Tube Defects publication trend
The graph below shows the total number of articles in fetal surgery techniques for neural tube defects across all publications each year (not limited to Nature Index journals).
Technical terms
Neural tube defect: Congenital malformation caused by failure of the neural tube to close during early embryogenesis.
Myelomeningocele: Form of spina bifida in which meninges and spinal cord protrude through a vertebral defect.
Fetoscopic surgery: Minimally invasive intrauterine procedure using endoscopic instruments inserted through small uterine ports.
Hysterotomy: Surgical incision into the uterine wall, typically employed in open fetal operations.
Ventriculoperitoneal shunt: Implantable device that diverts cerebrospinal fluid from cerebral ventricles to the peritoneal cavity.
Biocellulose patch: Biomaterial used to cover the neural placode in fetoscopic repair without requiring dural suture.
References
- Fetal surgery for open spina bifida. The Obstetrician & Gynaecologist (2019).
- Global Policy and Practice for Intrauterine Fetal Resuscitation During Fetal Surgery for Open Spina Bifida Repair. JAMA Network Open (2023).
- Maternal complications following open and fetoscopic fetal surgery: A systematic review and meta‐analysis. Prenatal Diagnosis (2019).
- Percutaneous fetoscopic spina bifida repair: effect on ambulation and need for postnatal cerebrospinal fluid diversion and bladder catheterization. Ultrasound in Obstetrics and Gynecology (2021).
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