Aim:The advantages of fetal spina bifida repair over postnatal repair were accepted with the publication of the Management of Myelomeningocele Study (MOMS). However, the long-term effects, sequelae, and pathology of fetal surgery are still unclear. Tethered cord recurrence and the need for additional surgery after fetal surgery remain a problem. Inclusion cysts are one reason for reoperation after fetal surgery. Could using a fetoscopic surgical bovine pericardial patch result in fewer inclusion cysts and consequently less granulation tissue?Material and Methods:This study evaluated the long-term results of nine cases undergoing myelomeningocele repair using fetoscopic surgery, open fetal surgery, or postnatal surgery. We evaluated the occurrence of inclusion cysts and granulation tissue thickness at the surgical site and their effects on the clinical outcome using spinal magnetic resonance imaging (MRI) at the 7-year follow-up.Results:The granulation tissue at the surgical site was thicker in the prenatal open and postnatal repair groups compared with the fetoscopic repair group. Follow-up spinal MRI revealed an inclusion cyst in one patient who underwent fetoscopic repair versus all of the patients who underwent prenatal open repair and two patients who underwent postnatal myelomeningocele repair. The fetoscopic repair group had better clinical outcomes than the patients who underwent open repair. The patients who underwent prenatal repair had different levels of neurogenic bladder dysfunction. Although none of them needed a urological intervention, their bladder profiles required close follow-up, and their neurological outcomes were obviously better than their urological outcomes.Conclusion:Using a bovine pericardial patch in fetoscopic surgery may protect neural tissue, causing relatively less compression of the neural placode, fewer inclusion cysts, and as a result, less granulation tissue.