Prenatal surgery for myelomeningocele
William H Peranteau1, N Scott Adzick
1The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Current Opinion in Obstetrics & Gynecology
|February 12, 2016
Summary
Open fetal surgery for myelomeningocele (MMC) improves neurodevelopmental outcomes and reduces shunt needs compared to postnatal repair. Minimally invasive approaches require further research for safe clinical use.
Area of Science:
- Fetal Medicine
- Pediatric Surgery
- Neuroscience
Background:
- Myelomeningocele (MMC) is a severe congenital condition requiring surgical intervention.
- Fetal surgery has emerged as a potential alternative to traditional postnatal repair.
- Evaluating the comparative outcomes of different fetal surgical approaches is crucial.
Purpose of the Study:
- To review and compare the outcomes of fetal surgery for myelomeningocele (MMC) versus postnatal repair.
- To identify areas for future research to enhance fetal MMC repair techniques.
Main Methods:
- Systematic review of recent studies on fetal MMC repair.
- Comparison of outcomes between open fetal repair and minimally invasive fetal repair.
- Analysis of maternal and neonatal complications and neurodevelopmental results.
Main Results:
- Open fetal MMC repair is associated with improved neurofunctional outcomes and reduced need for ventricular shunts compared to postnatal repair.
- Open fetal repair carries risks of increased maternal complications and preterm birth.
- Minimally invasive fetal repair, while feasible, presents challenges including longer operative times, membrane complications, earlier birth, and persistent cerebrospinal fluid leakage.
Conclusions:
- Open prenatal MMC repair is a viable option for select patients at specialized centers, offering improved postnatal outcomes.
- Further research is needed to optimize minimally invasive fetal repair techniques for broader clinical application.
