The First Open Fetal Surgery for Myelomeningocele Repair in a Bicornuate Uterus With Anterior Placenta in Central America: A Case Report From Nicaragua
4 affiliations
- 1Obstetrics and Gynecology, Hospital Militar Escuela "Dr. Alejandro Dávila Bolaños", Managua, NIC
- 2Neurosurgery, Hospital Militar Escuela "Dr. Alejandro Dávila Bolaños", Managua, NIC
- 3Anesthesia, Hospital Militar Escuela "Dr. Alejandro Dávila Bolaños", Managua, NIC
- 4Research, Hospital Militar Escuela "Dr. Alejandro Dávila Bolaños", Managua, NIC
Abstract
Open fetal surgery for myelomeningocele (MMC) has shown superior outcomes compared with postnatal repair, but it remains unavailable in most low- and middle-income countries (LMICs). We report the first open fetal MMC repair performed in Central America, in a patient with a bicornuate uterus, anterior placenta, and a gestational age beyond conventional criteria. A 27-year-old woman (BMI: 28.6 kg/m²) with epilepsy treated with carbamazepine and late prenatal care was referred at 26 5/7 weeks for a fetus with lumbosacral MMC, lemon sign, bilateral ventriculomegaly (10.5 mm), and an obliterated posterior fossa. A bicornuate uterus with an anterior placenta was identified. After multidisciplinary evaluation involving Maternal-Fetal Medicine, Fetal Surgery, Pediatric Neurosurgery, Neonatology, and Anesthesiology, open fetal microneurosurgery was performed at 27 5/7 weeks using microsurgical myeloplasty with continuous intraoperative Doppler monitoring.
Postoperative surveillance showed stable ventriculomegaly, regression of posterior fossa herniation, and an intact repair site. Cesarean delivery at 33 weeks was performed for severe oligohydramnios secondary to premature rupture of membranes, resulting in the birth of a 2,060 g male with Apgar scores of 8/9 and intact lumbar closure. The neonate required eight days in the neonatal intensive care unit (NICU) and did not require cerebrospinal fluid (CSF) diversion. Follow-up to postnatal day 47 confirmed a favorable neurological outcome. Open fetal MMC repair was feasible in an LMIC hospital with appropriate multidisciplinary coordination, even in the presence of a bicornuate uterus with anterior placenta and a gestational age beyond conventional criteria. During the documented follow-up period, the neonate showed favorable short-term neurological outcomes without the need for CSF diversion.
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BibTeX
@article{castillo2026first,
title = {{The First Open Fetal Surgery for Myelomeningocele Repair in a Bicornuate Uterus With Anterior Placenta in Central America: A Case Report From Nicaragua}},
author = {Alma Celeste Avilés Castillo and María Esther Suárez García and José Luis Rodríguez and Rodrigo Gonzalez and Oswaldo José Pérez Vargas and Marcela Conrado Chamorro and José Luis Villavicencio Bermudez and Jasser Logo Cabrebra and Jehmis Guevara Guevara and Christopher Kaleb Romero Ríos},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117452},
url = {https://doi.org/10.7759/cureus.117452},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The First Open Fetal Surgery for Myelomeningocele Repair in a Bicornuate Uterus With Anterior Placenta in Central America: A Case Report From Nicaragua
AU - Alma Celeste Avilés Castillo
AU - María Esther Suárez García
AU - José Luis Rodríguez
AU - Rodrigo Gonzalez
AU - Oswaldo José Pérez Vargas
AU - Marcela Conrado Chamorro
AU - José Luis Villavicencio Bermudez
AU - Jasser Logo Cabrebra
AU - Jehmis Guevara Guevara
AU - Christopher Kaleb Romero Ríos
PY - 2026
DA - 2026/10/04
JO - Cureus
DO - 10.7759/cureus.117452
UR - https://doi.org/10.7759/cureus.117452
AB - Open fetal surgery for myelomeningocele (MMC) has shown superior outcomes compared with postnatal repair, but it remains unavailable in most low- and middle-income countries (LMICs). We report the first open fetal MMC repair performed in Central America, in a patient with a bicornuate uterus, anterior placenta, and a gestational age beyond conventional criteria. A 27-year-old woman (BMI: 28.6 kg/m²) with epilepsy treated with carbamazepine and late prenatal care was referred at 26 5/7 weeks for a fetus with lumbosacral MMC, lemon sign, bilateral ventriculomegaly (10.5 mm), and an obliterated posterior fossa. A bicornuate uterus with an anterior placenta was identified. After multidisciplinary evaluation involving Maternal-Fetal Medicine, Fetal Surgery, Pediatric Neurosurgery, Neonatology, and Anesthesiology, open fetal microneurosurgery was performed at 27 5/7 weeks using microsurgical myeloplasty with continuous intraoperative Doppler monitoring. Postoperative surveillance showed stable ventriculomegaly, regression of posterior fossa herniation, and an intact repair site. Cesarean delivery at 33 weeks was performed for severe oligohydramnios secondary to premature rupture of membranes, resulting in the birth of a 2,060 g male with Apgar scores of 8/9 and intact lumbar closure. The neonate required eight days in the neonatal intensive care unit (NICU) and did not require cerebrospinal fluid (CSF) diversion. Follow-up to postnatal day 47 confirmed a favorable neurological outcome. Open fetal MMC repair was feasible in an LMIC hospital with appropriate multidisciplinary coordination, even in the presence of a bicornuate uterus with anterior placenta and a gestational age beyond conventional criteria. During the documented follow-up period, the neonate showed favorable short-term neurological outcomes without the need for CSF diversion.
SN - 2168-8184
ER -