Fetal surgery for spina bifida: past, present, future
1The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. adzick@email.chop.edu
Seminars in Pediatric Surgery
|February 12, 2013
Summary
Fetal surgery for myelomeningocele (MMC) before 26 weeks
Area of Science:
- Neuroscience
- Developmental Biology
- Surgical Innovation
Background:
- Open spina bifida (myelomeningocele, MMC) is a prevalent birth defect causing lifelong disability.
- Current postnatal surgical management offers limited improvement in neurological outcomes.
- The underlying cause of neurological deficits is increasingly understood as chronic in-utero damage to exposed neural tissue.
Purpose of the Study:
- To evaluate the safety and efficacy of fetal surgical repair for myelomeningocele.
- To compare outcomes of fetal surgery versus standard postnatal repair.
- To assess the impact of in utero repair on neurological function and hydrocephalus.
Main Methods:
- A prospective, randomized clinical trial (MOMS trial) was conducted.
- Fetal myelomeningocele repair was performed before 26 weeks' gestation.
- Outcomes were compared between the fetal surgery group and a historical control group receiving postnatal repair.
Main Results:
- Fetal surgery preserved neurologic function compared to postnatal repair.
- In utero repair reversed hindbrain herniation (Chiari II malformation).
- Ventriculoperitoneal shunt placement for hydrocephalus was obviated in a significant portion of the fetal surgery group.
- Fetal surgery carries risks, including uterine scarring and premature birth.
Conclusions:
- Fetal surgical repair of myelomeningocele before 26 weeks' gestation is a viable option for selected patients.
- This intervention can improve neurological outcomes and reduce the need for shunting.
- Further research is needed to understand long-term impacts and refine surgical techniques.
