Open fetal surgery for neural tube defects

Area of Science:

• Neuroscience
• Developmental Biology
• Surgical Innovation

Background:

• Myelomeningocele (MMC) is the most common congenital central nervous system defect, causing significant physical limitations due to in utero neural injury.
• Traditional treatment involves postnatal surgical closure and management of cerebrospinal fluid (CSF) issues, such as ventricular shunting.
• Advances in prenatal diagnosis and understanding of fetal development have paved the way for in utero interventions.

Purpose of the Study:

• To evaluate the efficacy and safety of fetal myelomeningocele (fMMC) closure compared to standard postnatal repair.
• To assess the impact of prenatal intervention on neurological outcomes and the need for CSF shunting.
• To review the data from the Management of Myelomeningocele Study (MOMS trial) and its implications for clinical practice.

Main Methods:

• Prospective, randomized, multicenter trial (MOMS trial) comparing in utero fMMC closure with routine postnatal closure.
• Evaluation of neurological function, need for shunting, and hindbrain herniation in both groups.
• Monitoring of maternal and neonatal complications, including prematurity.

Main Results:

• The prenatal repair group showed a reduced need for shunting and reversal of hindbrain herniation.
• Improved neurological function was observed in infants who underwent fetal MMC closure.
• Increased rates of maternal complications and prematurity were noted in the prenatal surgery group.

Conclusions:

• Fetal myelomeningocele (fMMC) closure, as demonstrated by the MOMS trial, is a viable therapeutic option for selected pregnancies.
• Prenatal repair offers significant neurodevelopmental benefits but requires careful consideration of maternal and neonatal risks.
• fMMC closure has become a standard of care option for pregnancies diagnosed with spina bifida prenatally.