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StayCurrentMD
Fetoscopic Repair of Myelomeningocele (MMC)
With Dr. Fung Lim · hosted by Dr. Rod Gerardo
Chapter 1 of 6 · Fundamentals
Introduction
Introduction to Fetoscopic Myelomeningocele Repair
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Prenatal repair is most commonly done between 22 and 26 weeks gestation.
For maternal access, either a transverse incision or a midline incision may be used.
The amniotic cavity is expanded using humidified and heated carbon dioxide, which creates more space to do the repair.
A camera is inserted into the amniotic cavity through the first port to enable visualization inside the womb.
Two additional ports are placed under direct vision to allow placement of instruments for the repair.
A stabilization stitch is placed in the baby's upper back above the spina bifida.
Once the sac is completely open, the placode is freed.
Untethering allows the placode to fall back down nicely into the spinal canal.
To protect the placode, a patch is placed into the defect and anchored on one end to the baby's back using dissolvable sutures.
A second patch is placed to give additional protection and is secured with dissolvable sutures.
The skin is closed over the spinal defect using dissolvable sutures when the baby has enough skin to do so.
When the defect is too big and the two ends of skin cannot be pulled together, a skin patch is used to form a watertight closure.
Port sites are closed with dissolvable sutures.
The amniotic fluid that was removed is replaced with warm fluid and antibiotics are placed into the amniotic cavity.
Neural tube defects are the most common congenital central nervous system anomaly.
Myelomeningocele or spina bifida is the most common neural tube defect.
In myelomeningocele, the patient is born with a cleft in the vertebral column and a defect in the skin, so the meninges and the spinal cord are exposed.
The patient may be left with neural defects based on the level of the spinal cord where the lesion is.
Under ultrasound guidance, the first port is placed.
Anesthesia is induced on the baby via an intragluteal injection.
The first step is to open the sac, then dissect around the sac circumferentially.
The placode is the open area of exposed neural tissue.
A skin flap is created to loosen up the skin, which will help form a watertight closure of the spinal defect.
The mother and the fetus are monitored postoperatively, and if able, the baby is delivered vaginally at term.