The clinical experience of fetoscopic repair of myelomeningocele in Taiwan: The dilemma in prenatal decision-making and first successful case

Abstract

Objective: Objective: Myelomeningocele (MMC) is the most severe type of spina bifida, with an incidence of 1.87 per 10,000 live births in Taiwan. Exposure of the lesion to amniotic fluid exacerbates neurological outcomes, while fetal surgery for MMC repair, now a routine practice, improves postnatal outcomes. However, Asian women and their families often find it difficult to accept prenatal defects, leading nearly all pregnancies with fetal MMC to opt for termination without considering fetal surgery. Materials and methods: In Taiwan's first approved trial of fetoscopic MMC repair, we prospectively recruited 15 cases from 2020 to 2023. Final diagnoses were confirmed using MRI and ultrasound. The medical team provided non-direct consultations to discuss possible outcomes of fetal surgery with family members. For those opting for fetal surgery, we offered total percutaneous fetoscopic MMC repair. Results: Over 30 months, 14 of 15 cases (93%) chose to terminate their pregnancies between 18 and 26 weeks of gestational age. Decision factors included potential disabilities, morbidities, economic, social, and psychological aspects. Despite supportive groups in the country, the termination rate remained high among the Chinese population. One out of the 15 cases underwent fetal surgery successfully, resulting in a 30-month-old child without motor function delays, able to walk and run naturally. Conclusion: We initiated the first fetoscopic MMC repair in Taiwan with promising outcomes, though we faced a high termination rate here and similar situation in other Asian countries. Continuous social education through media could play a crucial role in changing perceptions and increasing acceptance of fetal surgery.

Keywords

• Fetoscopy
• Myelomeningocele
• Fetal surgery