Fetoscopic Spina Bifida Repair

The surgery focuses on two main goals:

1. Neuro-protection: By closing the skin over the spinal defect, we stop the amniotic fluid from further damaging the delicate spinal nerves.
2. Reversing the Chiari II Malformation: When the spine is open, the fluid pressure in the brain drops, causing the hindbrain to be pulled down into the neck. Closing the spine 'plugs the leak,' allowing the brain to shift back up, which often prevents the need for a brain shunt after birth.

Not every case of Spina Bifida is suitable for fetal surgery. Candidacy is determined by:

• Timing: Must be performed between 22.0 and 25.6 weeks.
• Defect Level: Usually between the Upper Lumbar (L1) and Sacral (S1) vertebrae.
• Brain Signs: The presence of the 'Chiari II' malformation (hindbrain herniation).
• Maternal Health: The mother must be healthy and have a normal BMI to ensure the safety of the keyhole approach.

Candidate assessment usually includes:

1. High-resolution ultrasound to map the lesion and assess the brain, legs, feet, and other anatomy.
2. Fetal MRI when it adds information about the brain or spinal anatomy.
3. Genetic assessment and diagnostic testing where appropriate.
4. Maternal review for anaesthetic, surgical, obstetric, and future-pregnancy risks.
5. Multidisciplinary counselling involving fetal medicine, fetal surgery, paediatric neurosurgery, neonatology, anaesthesia, genetics, and psychology or counselling support.

When prenatal repair is considered, the responsible specialist centre must explain fetoscopic, open, and postnatal-repair pathways; uncertainty in comparative outcomes; the possibility of conversion or additional neonatal surgery; and risks including preterm birth, membrane rupture, bleeding, infection, placental complications, and maternal morbidity. The procedure should occur only with institutional approval, documented informed consent, appropriate research or innovation governance where relevant, prospective outcome registration, and formal audit.

Randomised evidence for prenatal open repair shows benefits for selected fetuses, including lower shunt use and improved motor outcomes, alongside important maternal and prematurity risks. Fetoscopic techniques continue to evolve, and outcomes vary by technique and centre experience. Published group averages cannot predict an individual child's mobility, bladder or bowel function, cognition, need for shunting, gestational age at birth, or maternal outcome.

Suspected open spina bifida should be referred promptly for detailed assessment and balanced counselling because eligibility windows are gestation-dependent. Fetus.ae provides assessment, counselling, and coordination of an appropriate specialist pathway; this page does not state that fetoscopic spina-bifida repair is routinely performed by our unit.