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Ultrasound Obstet Gynecol. 2019 Jun 20. doi: 10.1002/uog.20373. [Epub ahead of print]

Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy assisted fetoscopic or open approach.

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Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States.
Department of Radiology, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States.
Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, United States.
Department of Neurosurgery, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States.



To assess brain microstructure in a cohort of fetuses and infants that underwent prenatal Fetoscopic or Open myelomeningocele (MMC) repair.


Longitudinal retrospective cohort study. A total of 57 fetuses who met Management of Myelomeningocele Study (MOMS) trial criteria underwent prenatal MMC repair (27 Fetoscopic and 30 Open) at 23-25.6 weeks of gestational age (GA). Presurgical MRI diffusion-weighted imaging (DWI) was obtained in 30 cases (14 Fetoscopic vs. 16 Open) and in 48 cases at 6 weeks post-surgery (24 Fetoscopic vs. 24 Open). At 1 year of age, MRI DWI scans from 23 infants were collected (5 Fetoscopic vs. 18 Open). Apparent diffusion coefficient (ADC) values from basal ganglia, frontal, occipital and parietal lobes, mesencephalon and genu as well as splenium of the corpus callosum were calculated. ADC values at each of these time points and the % change in the ADC values were compared. ADC values at 6 weeks after surgery for both of the prenatally repaired groups were compared to a control group of 8 healthy fetuses. Cases and controls were matched for GA at time of MRI. ADC values were compared using the t- test for independent samples (or Mann Whitney test if non-normally distributed) and multivariate analyses, adjusting for GA or age at MRI and mean ventricular width.


There were no differences in the degree of ventriculomegaly, GA at surgery, or GA/postnatal age at MRI between the groups. No differences in ADC values were seen between both groups. Additionally, there were no differences observed in the % change in ADC values either.


Fetoscopic MMC repair has no detectable effects on brain microstructure when compared to babies repaired by an open hysterotomy technique. Carbon dioxide insufflation of the uterine cavity during fetoscopy does not seem to have any isolated deleterious effects in fetal brain microstructure. This article is protected by copyright. All rights reserved.


Brain; Fetal MRI; Fetal surgery; Fetoscopic spina bifida repair; Myelomeningocele; Neural tube defect; Open hysterotomy spina bifida repair; Spina bifida


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