Microneurocirugía intrauterina para la corrección de espina bífida congénita: primer caso exitoso reportado en Venezuela

Abstract

Congenital spina bifida is a malformation of the central nervous system that occurs during embryological development. Its etiology is multifactorial and it is estimated that it affects 1:1500 pregnancies, in which motor and sensory deficits, secondary to spinal cord injury, hydrocephalus and Arnold-Chiari II malformation are the most significant findings. Prenatal surgical treatment has been described through the open approach, microneurosurgery, and fetoscopic resolution, with well-known advantages and disadvantages, but which invariably improve postnatal prognosis and the severity of neurological sequelae, as well as the need for ventriculoperitoneal shunt. We present the first case of open microneurosurgery for intrauterine repair of myelomeningocele performed in Venezuela, a novel technique characterized by a minimum uterine incision of 20-30 mm, reduced fetal manipulation and maintenance of a normal volume of amniotic fluid throughout the process, in a patient at 24 weeks of gestation.