[Maternal-fetal surgery for spina bifida: future perspectives].
L Joyeux1, G E Chalouhi2, Y Ville2
1Service de chirurgie pédiatrique, hôpital d'enfants, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon, France.
Summary
Open spina bifida (myelomeningocele) surgery before birth shows improved outcomes for children. Prenatal surgery enhances motor function and reduces hindbrain issues, offering a vital therapeutic option for this congenital abnormality.
Area of Science:
- Neurology
- Developmental Biology
- Surgical Innovation
Context:
- Myelomeningocele (MMC) is a severe congenital abnormality with significant morbidity.
- Current postnatal surgical techniques for MMC have seen limited advancement.
- MMC pathogenesis involves primary neural tube defects and secondary amniotic fluid-induced damage.
Purpose:
- To evaluate the efficacy of open maternal-fetal surgery (OMFS) for myelomeningocele.
- To compare prenatal surgical outcomes with traditional postnatal surgical interventions.
- To assess the impact of OMFS on neurological, motor, and urological functions.
Summary:
- A randomized trial demonstrated that open maternal-fetal surgery (OMFS) for myelomeningocele (MMC) is a viable therapeutic option.
- Prenatal MMC repair resulted in enhanced lower limb motor function and reduced Chiari II malformation severity compared to postnatal surgery.
- Long-term follow-up indicates better neurocognitive, motor, and bladder-sphincter outcomes for prenatally operated children.
Impact:
- OMFS offers improved functional outcomes for children with myelomeningocele.
- Informing parents about OMFS and its availability is crucial for patient care in France.
- Future research aims to refine less invasive prenatal techniques and address complications like preterm birth.
Keywords:
Chirurgie maternofœtaleDiagnostic anténatalFetal surgeryFetoscopyFœtoscopieMyelomeningoceleMyéloméningocèlePrenatal diagnosisSpina bifida
