Minimally Invasive Fetoscopic Regenerative Repair of Spina Bifida - A Pilot Study

Inclusion Criteria * Pregnant women - maternal age 18 years or older * Gestational age at the time of the procedure between 19 0/7 weeks and 25 6/7 weeks * Singleton pregnancy. * MMC diagnosis with the upper boundary located between Thoracic 1 (T1) and Sacral 1 (S1). * Evidence of hindbrain herniation (confirmed on MRI to have an Arnold-Chiari type II malformation). * Absence of chromosomal abnormalities and associated anomalies. * Normal karyotype and/or normal chromosomal microarray (CMA) by invasive testing (amniocentesis or CVS). If there is a balanced translocation with normal CMA with no other anomalies the candidate can be included. * Family has considered and declined the option of termination of the pregnancy at less than 24 weeks. * Family meets psychosocial criteria (sufficient social support, ability to understand requirements for this study). * Pregnant subject capable of consenting for their own participation in this study. * Willingness to undergo an open MMC repair, if necessary * Parental/guardian permission (informed consent) for follow up of child after birth. Exclusion Criteria: * Exclusion Criteria * Fetal anomaly unrelated to MMC. * Multiple gestation * Declined invasive testing for karyotype (amniocentesis or CVS) * Severe kyphosis (defined as curvature of the spina (vertebras) higher than 30o degree measured by ultrasonography or magnetic resonance imaging). * Increased risk for preterm labor including short cervical length (\<2.0 cm), history of incompetent cervix with or without cerclage, and previous preterm birth. * Placental abnormalities (previa, abruption, accreta) known at time of enrollment. * A body-mass index ≥40 at first prenatal visit. * Contraindications to surgery including previous hysterotomy (whether from a previous classical cesarean, uterine anomaly such as an arcuate or bicornuate uterus, major myomectomy resection, or previous fetal surgery) in active uterine segment. * Technical limitations precluding fetoscopic surgery, such as uterine fibroids, fetal membrane separation, uterine anomalies incompatible with fetoscopy. * Amniotic Fluid Index (AFI) \< 6 cm if deemed to be due to fetal anomaly, poor placental perfusion or function, or membrane rupture. Low amniotic fluid volume that responds to maternal hydration is not an exclusion. * Maternal-fetal Rh isoimmunization, Kell sensitization or neonatal alloimmune thrombocytopenia affecting the current pregnancy. * Maternal HIV, Hepatitis-B, Hepatitis-C status positive because of the increased risk of transmission to the fetus during maternal-fetal surgery. If the patients HIV or Hepatitis status is unknown, the patient must be tested and found to have negative results before enrollment. * Maternal medical condition that is a contraindication to surgery or anesthesia. * A score of ≥ 29 on the Beck Depression Inventory (BDI) at screening * Maternal hypersensitivity to collagen * Patient does not have a support person (i.e. Spouse, partner, mother) available to support the patient for the duration of the pregnancy. * Inability to comply with the travel and follow-up requirements of the trial. * Participation in another intervention study that influences maternal and fetal morbidity and mortality or participation in this trial in a previous pregnancy.