Fetal surgery for neural tube defects
Enrico Danzer1, Mark P Johnson1
1The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia and the Perelman School of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Seminars in Fetal & Neonatal Medicine
|October 15, 2013
Summary
Maternal-fetal surgery for myelomeningocele (MMC) before 26 weeks gestation improves outcomes like reduced shunting and better neurological function. However, risks of premature delivery and maternal complications exist.
Area of Science:
- Fetal Surgery
- Neuroscience
- Obstetrics
Background:
- Myelomeningocele (MMC) is a severe birth defect affecting the spinal cord.
- Previous treatments involved postnatal surgery with limited success.
- The Management of Myelomeningocele Study (MOMS) aimed to evaluate in-utero repair.
Purpose of the Study:
- To critically review the rationale for in-utero MMC intervention.
- To analyze pathological findings, animal models, and early clinical data.
- To present the results of the MOMS randomized trial.
Main Methods:
- Prospective, randomized, controlled, multicenter trial (MOMS).
- Maternal-fetal surgery for MMC performed before 26 weeks gestation.
- Evaluation of outcomes including shunting, hindbrain herniation, and neurological function.
Main Results:
- Maternal-fetal surgery significantly decreased the need for ventriculoperitoneal shunting.
- In-utero repair reduced hindbrain herniation and preserved neurological function.
- Significant risks included premature delivery and maternal complications.
Conclusions:
- Maternal-fetal surgery for MMC offers substantial benefits but carries risks.
- The MOMS trial provides critical evidence supporting selective in-utero intervention.
- Ongoing research explores alternative techniques and refined surgical approaches.
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