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Recording available 2/16-5/2

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Poster Session 2

Category: Fetal Intervention

Poster Session 2

(568) Hindbrain Herniation Reversal and CSF Diversion Following Fetoscopic Spina Bifida Repair with Umbilical Cord Patch

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Linoy Batsry, MD

Fetal intervention fellow
UTHealth
houston, Texas, United States

Coauthor(s)

RP

Rajan Patel, MD

TCH
houston, Texas, United States
LM

Lovepreet Mann, MBBS (she/her/hers)

UTHealth Houston Fetal Institute; Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
CB

Clifton O. Brock

Midwest Fetal Care Center, Children’s Minnesota, Minneapolis, Minnesota
minneapolis, Minnesota, United States
SZ

Sen Zhu, PhD

UTHealth Houston Fetal Institute; Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
EG

Elisa Garcia, MPH, RN

UTHealth Houston Fetal Institute; Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
AS

Ashley Salazar, DNP

UTHealth Houston Fetal Institute; Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Jimmy Espinoza, MD, MSc

Professor
UTHealth Houston Fetal Institute; Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
SF

Stephen A. Fletcher, MD

Neurosurgery, Pediatric Neurosurgery
Division of Pediatric Neurosurgery, Department of Pediatric Surgery, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Kuojen Tsao, MD

Professor
Division of Pediatric General & Thoracic Surgery, Department of Pediatric Surgery, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
PY

Peter Yang

UTHealth
houston, Texas, United States
MA

Mary Austin, MD

Division of Pediatric General & Thoracic Surgery, Department of Pediatric Surgery, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Ramesha Papanna, MD, MPH

Professor
University of Texas Health Science Center in Houston, McGovern Medical School
Houston, Texas, United States

Objective:
In-utero closure of spina bifida improves hindbrain herniation and reduces the need for cerebrospinal fluid (CSF) diversion (ventriculoperitoneal shunt or endoscopic third ventriculostomy). Fetoscopic spina bifida repair with human umbilical cord patch (fSB-HUC) uses a patch to create a watertight closure compared to the myofascial closure of open in-utero repair. This study compares rates of hindbrain herniation reversal (HHR) on MRI and CSF diversion at 12 months following fSB-HUC versus open in-utero repair.

Study Design:
This is a secondary analysis comparing patients from a single-arm interventional study conducted at a single tertiary center to a prospective cohort and historical control groups of patients who underwent open in-utero repair at the same institution (oSB), as well as to a de-identified individual-level database from the open in-utero repair group from the MOMS trial (MOMS). Patients eligible for open in-utero repair were offered fSB-HUC. Following placode dissection, the HUC patch was sutured circumferentially; skin closure was then performed with or without an additional patch. Preoperative neuroradiological features and 12-month outcomes were compared between the three groups. The primary outcomes were complete HHR on 12-month MRI (defined as the obex at or above the level of the foramen magnum) and CSF diversion within 12 months.

Results:

Of 49 patients who underwent fSB-HUC, 46 completed 12 months MRI and were included in the analysis (Table 1). The rate of complete HHR was significantly higher in the fSB-HUC group compared to the MOMS group (p=0.010). Rates of CSF diversion within the first year of life were comparable across the three groups (p=0.592) and were not influenced by HHR status. In the fSB-HUC group, the pre-procedure hindbrain herniation improved in 41/46 (89%) compared to 12 months degree of hindbrain herniation on MRI (p< 0.001, Figure 1).

Conclusion:

fSB-HUC was associated with higher rates of complete HHR compared to MOMS, and comparable CSF diversion rates within 12 months compared to both oSB and MOMS.