Evaluation of Inclusion Cysts and Granulation Tissue After Prenatal and Postnatal Myelomeningocele Repair

AIM: To evaluate the long-term outcomes of nine patients who underwent myelomeningocele repair via fetoscopic surgery, open fetal surgery, and postnatal surgery. MATERIAL and METHODS: The presence of inclusion cysts and the thickness of granulation tissues at the surgical site were analyzed using spinal magnetic resonance imaging (MRI) at a 7-year follow-up to determine their impact on clinical outcomes. RESULTS: The spinal defect levels ranged from L2 to S2. Granulation tissue at the surgical site was thicker in the prenatal open and postnatal repair groups when compared to the fetoscopic repair group. Follow-up spinal magnetic resonance imagings (MRIs) detected an inclusion cyst in one patient from the fetoscopic repair group, whereas all patients who underwent prenatal open repair and the two who underwent postnatal myelomeningocele repair developed inclusion cysts. Clinical outcomes were more favorable in the fetoscopic repair group compared to those who underwent open repair. Patients who underwent prenatal repair exhibited varying degrees of neurogenic bladder dysfunction. Although none required urological intervention, their bladder function necessitated close monitoring, and their neurological outcomes were noticeably better than their urological outcomes. CONCLUSION: We believe that inclusion cysts and granulation tissue affect the clinical outcome of patients after myelomeningocele repair and should be monitored during spinal follow-up.