Introduction: To describe the perinatal and neurological outcomes of fetuses with occipital encephalocele treated with intrauterine repair by open microneurosurgery. Methods: Between 2021 and 2025, a consecutive cohort of fetuses with occipital encephalocele referred to two fetal surgery centers in Nicaragua and Mexico were selected for intrauterine correction by open fetal microneurosurgery. Inclusion criteria were fetuses at less than 28 weeks with isolated occipital encephalocele, Chiari III malformation (obliteration of the cisterna magna with protrusion of cerebral tissue), and microcephaly. We report the procedure-related characteristics, perinatal and neurological outcomes (hydrocephalus, meningitis, seizures, cognitive delay, motor dysfunction, and visual impairment) within the first 12 months of age. Results: Twelve cases were evaluated during the study period but only 6 cases were selected for fetal intervention. Open fetal microneurosurgery was successfully performed in all cases at a median gestational age (GA) of 25+2 weeks+days, with a median surgical time of 93 minutes. Regression of Chiari and reversal of microcephaly was observed in 4/6 and 6/6 cases, respectively. The median GA at birth was 36+5 weeks+days. Preterm rupture of the membranes and preterm delivery was reported in 3/6 cases. No cases of perinatal death were reported. Within the first 12 months of age, none of the children developed meningitis, cognitive delay, or hydrocephalus requiring ventriculoperitoneal shunting. Motor dysfunction, seizures and visual disorders were reported in 1/6, 1/6 and 3/6 cases, respectively. Conclusion: In fetuses with occipital encephalocele, open fetal microneurosurgery is feasible and is associated with good perinatal and neurological outcomes.
Cruz‐Martínez et al. (Mon,) studied this question.
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