Systematic Review of Minimally InvasiveFetoscopic Surgery for Spina Bifida: Fetal,Neonatal, and Maternal Outcomes
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Abstract
Background: Open spina bifida (myelomeningocele) benefits from prenatal repair, but open fetal surgery through hysterotomy increases maternal morbidity and mandates cesarean delivery in the index and future pregnancies. Minimally invasive fetoscopic repair aims to preserve fetal benefit while reducing uterine scar complications. Objective: The objective of the study is to synthesize evidence on minimally invasive fetoscopic repair of open spina bifida and summarize fetal, neonatal/child, and maternal outcomes, alongside evidence quality. Materials and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020, PubMed/MEDLINE, Scopus, Web of Science, Embase, and LILACS were searched from 1 January 2009 to 31 December 2025. Two reviewers screened records, extracted data, and assessed risk of bias (RoB 2 for randomized trials and ROBINS-I/NOS for non-randomized studies). A narrative synthesis was conducted because outcome
reporting and study designs were heterogeneous. Results: Searches retrieved 1476 records; after deduplication and
screening, 11 studies were included (one randomized trial and 10 observational reports/case series/case report).
Fetoscopic approaches (predominantly percutaneous) were feasible and were associated with low reported uterine
dehiscence/rupture and substantial rates of vaginal delivery in larger series, while gestational age at delivery
commonly remained preterm, and membrane complications were frequent. Across included fetoscopic cohorts,
a substantial proportion of infants still required cerebrospinal fluid diversion by 12 months, indicating persistent
hydrocephalus risk despite prenatal intervention. Overall evidence certainty was limited by non-randomized
designs, variable eligibility criteria, inconsistent maternal outcome reporting, and incomplete long-term follow-up.
Conclusion: Minimally invasive fetoscopic repair is a promising alternative to open fetal surgery for reducing
hysterotomy-related maternal risks, but preterm birth and hydrocephalus remain important residual risks. High-
quality prospective comparative studies with standardized outcomes and longer follow-up are needed.
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