Neurodevelopmental Outcomes after Fetoscopic Myelomeningocele Repair.

Objectives: To report the neurodevelopmental outcomes after a fetoscopic myelomeningocele (MMC) repair and to compare them with children who had an open-hysterotomy repair or a postnatal repair.

Study design: 132 infants were included (prenatal repair: 93 [69 fetoscopic and 24 open-hysterotomy]; postnatal repair: 39). Neurodevelopmental outcomes at or beyond 18 months were evaluated by a developmental pediatrician using the Capute scales (Clinical Adaptive Test [CAT]/ Clinical Linguistic & Auditory Milestone Scale [CLAMS]) and/or during parental interview using Developmental Profile 3 (DP-3) test. Scores were examined against reference values at each gestational age. A "normal" score was defined when >=70%. Neurodevelopmental scores were compared while adjusting for infants' age at the time of testing and the need for hydrocephalus treatment.

Results: After a fetoscopic repair, normal CLAMS results were observed in 25/33 (75.8%) of the cases and normal CAT in 23/33 (69.7%); DP-3 showed normal social-emotional scores in 60/65 (92.3%), normal cognition in 55/65 (84.6%), normal communication in 51/65 (78.5%), normal adaptive behavior in 48/65 (73.8%), normal general development in 39/65( 60%) and normal physical score in 31/65 (47.7%) of the cases. Children who underwent a fetoscopic repair had similar neurodevelopmental outcomes compared with those who had an open fetal surgery repair. There was a significantly higher proportion of children with "normal" CLAMS (25/33 [75.8%] vs 12/39 [30.8%], p<0.01) and "normal" CAT (23/33 [69.7%] vs 16/39 [41.0%], p=0.04) in the fetoscopic group compared with the postnatal repair group.

Conclusion: Children who undergo laparotomy-assisted fetoscopic MMC repair present with normal neurodevelopmental outcomes in two thirds of the cases included in this study at/or beyond 18 months of age and had similar neurodevelopmental outcomes as those who had an open fetal surgery repair.