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Federación Mexicana de Ginecología y Obstetricia, A.C.

2022, Number 01

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Ginecol Obstet Mex 2022; 90 (01)

Open spina bifida. Diagnosis, prognosis and options for intrauterine correction by open and fetoscopic fetal surgery

Lara-Ávila L, Martínez-Rodríguez M, Villalobos-Gómez R, Gámez-Varela A, Aguilar-Avidales K, López-Briones H, Estudillo-Moreno E, Chavelas-Ochoa F, Cruz-Martínez R

Language: Spanish
References: 35
Page: 73-83
PDF size: 295.64 Kb.


ABSTRACT

Background: Open spina bifida is the leading cause of infant disability; its prevalence is 4 to 5 cases per 10,000 births.
Objetivo: To describe the diagnostic methods, prognosis and outcomes of the different fetal surgical techniques reported for intrauterine correction of open spina bifida.
Methodology: PubMed, Embase, Scope, Scielo and Google Scholar were searched for all articles in English and Spanish published between January 1990 and March 2021 with the MeSH: "spina bifida", "fetal surgery", "myelomeningocele", "spina bifida", "fetal surgery", "myelomeningocele". Cases of open spina bifida with intrauterine correction by some fetal surgery technique were chosen.
Results: We found 694 articles and selected 15 studies that included cases of intrauterine correction of open spina bifida and two types of fetal surgical access. Compared to the current use of the classical open fetal surgery technique, fetoscopic techniques demonstrate lower risk of hysterotomy dehiscence and fewer cesarean births, although longer operative times and more complications. Minihysterotomy and microneurosurgery techniques have demonstrated fewer complications and lower risk of hysterotomy dehiscence compared to the classic open technique.
Conclusions: There are several variants in the surgical technique for open intrauterine spina bifida correction. The development of a better minimally invasive fetoscopic technique that demonstrates lower maternal and fetal risks and complications while maintaining the neurological benefits of prental repair is a current line of research by several groups.


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