Innovative Procedure Resolves Discrepancy in Fetal Myelomeningocele Diagnosis Prior to Surgery
Acclaimed maternal-fetal specialists at Orlando Health Women’s Institute Fetal Care Center continue to innovate specialized procedures to address rare conditions in complex pregnancies. The center’s multidisciplinary team recently pioneered a novel approach utilizing fetoscopy for successfully confirming diagnostic discrepancy prior to fetal myelomeningocele repair during pregnancy.
In early 2025, a couple sought a second opinion at Orlando Health for prenatal surgical repair of a fetal myelomeningocele, following another program’s denial due to a lack of acetylcholinesterase in the amniotic fluid analysis. Part of Orlando Health Women’s Institute, the center is one of only a few in the nation with the expertise to perform open fetal myelomeningocele repair.
Strict inclusion criteria for spina bifida surgery includes confirmation of an open neural tube defect (ONTD). “Upon our evaluation of the maternal-fetal dyad, we concluded the fetus possessed intracranial findings consistent with an open neural tube defect and a lumbosacral defect was appreciated on ultrasound — physical findings confirmed by fetal MRI,” says Cole Greves, MD, of the fetal care center. A board-certified maternal-fetal medicine specialist, Dr. Greves is recognized for his skill diagnosing and treating fetal anomalies and performing fetal surgical procedures.
The inconsistency between the fetal anatomic findings and the lack of acetylcholinesterase in the amniotic fluid made the defect’s status unclear. Specialists proposed performing fetoscopy to confirm fetal myelomeningocele prior to committing to the planned repair. If the ONTD was confirmed, surgery would proceed immediately. Not knowing which path would ultimately be pursued, the team was very intentional in its approach to minimize risk.
Using ultrasound guidance, a 13 gauge trocar needle was placed through the patient’s skin and uterus, and into the amniotic sac along the anticipated path of the possible fetal ONTD repair. A 1.3 mm fetoscopic lens was passed through the needle into the amniotic fluid, allowing direct visualization but obviating the need to commit to an open procedure prior to confirming that the lumbosacral lesion was a myelomeningocele.
Upon determination, the repair commenced and was completed without complications at 25 weeks gestation. The newborn was delivered at term in November 2025 with reversal of the Chiari malformation and a well-healed repair of the spina bifida.
“Our center is a place of innovation,” says Dr. Greves. “As advocates for both our maternal and fetal patients, we try to think outside the ordinary for their care.”
Multidisciplinary specialists at Orlando Health Women’s Institute Fetal Care Center have performed more than 60 cases of open fetal surgery. The center is recognized as a national leader in developing novel therapies, treatments and comprehensive services for complex and high-risk pregnancies.
