An illustrated history of fetal surgery for myelomeningocele

Today, fetal surgery for myelomeningocele (MMC) is the standard of care. From the initial concept to accepted practice, the story of fetal MMC (fMMC) repair involves innovation, persistence, collaboration, rigor, and courage. This illustrated history traces the pivotal moments, key figures, crucial relationships, and groundbreaking research that gave rise to this transformative operation in the United States. Beginning with Dr. Michael Harrison's "crazy idea" of fetal surgery in 1969, each decade brought advancements essential to the success of fMMC repair. The 1970s saw technological improvements in fetal ultrasonography and fetoscopy. The 1980s were marked by the first open fetal surgery, the founding of the International Fetal Medicine and Surgery Society (IFMSS), and the creation of animal models for fMMC. In the 1990s, positive results from animal experiments paved the way for the first successful human fMMC repairs, made possible through close collaboration among multidisciplinary teams. The 2000s were defined by the landmark MOMS trial, confirming the benefits of fetal repair and establishing its role in clinical practice. The 2010s witnessed rapid global expansion, with fetal MMC repair programs emerging in Europe, Latin America, and beyond, often adapting techniques for resource-limited settings. A resurgence in the fetoscopic approach further broadened the field, aiming to reduce maternal morbidity while preserving fetal benefit. Today, the legacy of this operation is reflected in the improved outcomes and quality of life of children and families worldwide, and in the enduring spirit of innovation and collaboration that continues to advance fetal therapy.