The First Open Fetal Surgery for Myelomeningocele Repair in a Bicornuate Uterus With Anterior Placenta in Central America: A Case Report From Nicaragua

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.