Children's Hospital Colorado

First Minimally Invasive MMC Spina Bifida Repair Performed in the Region

Children's Hospital Colorado | October 17, 2023

On Aug. 21, Chris Derderian, MD, pediatric and fetal surgeon, and a multidisciplinary care team performed a landmark procedure — a fetoscopic myelomeningocele (MMC) repair. The minimally invasive surgery repairs and closes the defects in a developing spine caused by MMC while a baby is still in the womb. 

What is MMC?

MMC is a severe form of spina bifida that occurs in approximately 1 in every 3,000 births. It happens when the spine doesn’t completely wrap around the spinal cord and leaves an opening in the spine that can lead to serious complications, including paralysis. Repairing MMC before the baby is born helps reduce the chance of complications it can cause if the hole grows larger.

Open vs. fetoscopic MMC repair

Since the Colorado Fetal Care Center opened in 2010, Children’s Colorado has offered the traditional open fetal procedure, achieving top outcomes. Children’s Colorado is among a few in the country and the only in the seven-state region to offer this leading-edge fetoscopic MMC repair surgery to patients.  

“The Colorado Fetal Care Center already offers most of our procedures fetoscopically,” Dr. Derderian said. “MMC repair was really the main procedure that, for decades, has been an open approach. We’re excited to be able to offer the fetoscopic approach to give families a choice that benefits both baby and parent.”  

How fetoscopic MMC repair works 

The start of a fetoscopic MMC surgery begins with an incision on the abdomen to expose the uterus. A multidisciplinary team of maternal-fetal medicine specialists, fetal surgeons, pediatric neurosurgeons, neonatologists and nurses place three small working ports – one port for the camera and the other two for surgical instruments – to perform the MMC repair. After making the repair, the surgery team closes the incisions and the baby continues healing and developing in the womb.

The benefits of prenatal MMC repair 

Research has shown that when compared to surgery after birth, prenatal MMC repair results in better motor function and a 50% decreased need for a shunt. Shunts, which help fluid drain from the brain after surgery, used to be somewhat common for babies with MMC. Surgery before birth also decreases exposure of nerves to amniotic fluid and allows the baby’s skin to grow around the repair as they continue to develop in the womb.  

One of the main benefits to the fetoscopic procedure is that a baby can be delivered vaginally. Both surgeries are great options depending on what works best for each family.

Fetoscopic MMC leads to life-changing results

“What we can do by operating on babies while they’re still developing in the uterus allows us to address concerns as early as possible, which leads to life-changing results for children,” Dr. Derderian said. “We are thrilled because this procedure also supports one of our core principles at the Colorado Fetal Care Center: providing care that benefits babies while also focusing on long-term impacts to birthing parents.”  

Fetoscopic MMC repair resources: