Second, the defect is closed primarily with interrupted vertical mattress sutures.
First, the neural placode is released through sharp circumferential dissection of the arachnoid lying between the neural placode margin and the junctional zone. Endoscopic closure of the myelomeningocele is done in two major steps. The fetus and myelomeningocele defect are observed under endoscopic guidance. A total of 300 cc of amniotic fluid are removed and the uterus is insufflated with humidified CO 2 gas. Two ports are placed 6 cm apart with ultrasound guidance into the fundus of the uterus. A transverse abdominal opening is made for uterine exposure. Materials and Methods: The mother is at 26 weeks gestation and ultrasonography work-up has revealed a myelomeningocele defect of the fetus at the 元-S1 levels. 3–5 Here we demonstrate our two-port endoscopic technique. 2 Endoscopic approaches eliminating the need for hysterotomy have been described. Open prenatal closure, however, necessitates hysterotomy and significantly increases the risk of preterm delivery and uterine dehiscence. 1 Fetal closure reduces the incidence of hydrocephalus and improves motor outcomes compared with conventional postnatal closure. The 2011 Management of Myelomeningocele Study established fetal closure as a treatment option. Issues include paraplegia, walking difficulties, bowel and bladder incontinence, and hydrocephalus. Introduction: Open neural tube defects are a common congenital abnormality with significant consequences for affected children and their families.
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