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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
Foundation Awardee
Foundation Awardee
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 3

Category: Fetal Intervention

Poster Session 3

(767) Fetoscopic Spina Bifida Repair Offers Similar Benefits to Open Approach Based on Imaging Outcomes

Thursday, February 12, 2026
10:30 AM - 12:00 PM  
Objective:
Fetoscopic repair of open neural tube defects (ONTDs) may reduce maternal and obstetrical risks compared to open repair via hysterotomy. However, it is unclear whether the fetoscopic approach confers similar fetal/neonatal benefits, specifically postoperative imaging and the need for cerebrospinal fluid (CSF) diversion.

Study Design:
This retrospective cohort study included all in-utero ONTD repairs performed between 2020 and 2024 at a single fetal care center. All repairs used an identical multi-layer myofascial flap. The primary outcome was postoperative lateral ventricle (LV) growth rate (mm/week). Secondary outcomes included trajectories of additional biometric markers on pre- and post-operative ultrasounds and incidence of CSF diversion within 12 months after delivery. Outcomes were compared between fetoscopic and open repairs using appropriate statistical methods.

Results:
Among 36 patients, 24 (66.7%) underwent open and 12 (33.3%) underwent fetoscopic repair. Myeloschisis was more frequent in the fetoscopic group (58.3% vs. 16.7%, p=0.02), and LV width at diagnosis trended toward significance (11.6 mm for fetoscopic vs. 9.8 mm for open, p=0.06). All other preoperative characteristics were similar. Postoperative LV growth rates did not differ between groups (0.56 mm/week for fetoscopic vs. 0.21 mm/week for open, p=0.14). Cerebellar and head growth rates were similar, and resolution of “banana” and “lemon” signs occurred at comparable rates. The mean gestational age at delivery was 35.7 weeks for fetoscopic and 36.3 weeks for open repair (p=0.89), and rates of postnatal CSF diversion were not significantly different.

Conclusion:
In our cohort, fetoscopic and open ONTD repair resulted in similar postoperative prenatal imaging findings and rates of postnatal CSF diversion, despite a higher proportion of myeloschisis in the fetoscopic group. The findings suggest that fetoscopic repair offers comparable fetal/neonatal benefit to open repair. Given its potential for reduced maternal and obstetric risk, fetoscopic repair should be offered for all patients considering in-utero ONTD repair.