Fetoscopic repair of myeloschisis: optimizing the three-layer closure

A 25-year-old female presented at 24 weeks and 2 days of gestation with suspected myeloschisis on fetal anatomical survey. Imaging demonstrated an L4-S4 defect, ventriculomegaly, and Chiari type II malformation. Closure remains one of the least standardized components of fetoscopic repair, although small studies have suggested that three-layer repair may reduce CSF leakage, shorten maternal hospitalization, decrease revision rates, and improve Chiari malformation outcomes. The patient underwent a three-port fetoscopic repair with three-layer closure. The authors showcase their approach and advocate for closure technique standardization and its correlation with long-term neurological outcomes in the post-Management of Myelomeningocele Study (MOMS) trial era. The video can be found here: https://stream.cadmore.media/r10.3171/2026.1.FOCVID25217.