Outcomes in prenatal vs. postnatal surgery for myelomeningocele: a systematic review and meta-analysis

This study was aimed at comparing the outcomes of fetal versus postnatal surgery for myelomeningocele through a systematic review and meta-analysis.

In accordance with the PRISMA guidelines, systematic searches of Medline, Embase, Web of Science, and Cochrane Central were undertaken from database inception to December 2024. Outcomes analyzed included neonatal and maternal complications, indication rate of ventriculo-peritoneal shunting (VPS), and long-term motor outcomes in children. Using a random-effects model, we evaluated clinical and functional outcomes. Sensitivity analyses addressed heterogeneity.

Eleven studies reporting on 751 patients undergoing in utero repair of myelomeningocele and 1169 undergoing postnatal repair. Fetal surgery significantly reduced the need for VPS (OR 0.08; CI 0.03-0.22; I² = 87%; p < 0.001) and improved independent ambulation in children (OR:3.89;CI:2.32-6.50; I² = 0%; p < 0.001). It also decreased the incidence of hindbrain herniation (OR:0.15;CI:0.04-0.61; I² = 58.0%; p = 0.008). However, fetal surgery was associated with higher maternal risks, such as oligohydramnios (OR:4.60;CI:1.31-16.25; I² = 45.4%; p = 0.018). No significant differences were observed in perinatal mortality between groups (OR 1.28; CI 0.46-3.54; I² = 0.0%; p = 0.632). Sensitivity analyses confirmed robustness by identifying the source of heterogeneity in key outcomes.

This study demonstrates that fetal surgery significantly reduces hydrocephalus and improves motor outcomes compared to postnatal repair, though it is associated with higher rates of maternal complications.