[Prenatal repair of open spina bifida: history, present, and future]
José Miguel Müller1, Emilia González1, Edgardo Corral1
1Hospital Dr. Franco Ravera Zunino, Rancagua, Chile.
Insights
Fetal surgery for open spina bifida offers significant benefits, including improved motor function. However, its implementation in Chile faces barriers, necessitating improved access to this gold standard treatment.
Area of Science:
- Medical Science
- Surgical Innovation
- Pediatric Neurology
Background:
- Open spina bifida is a complex congenital malformation requiring specialized treatment.
- Fetal surgery for open spina bifida is recognized globally as the preferred intervention.
- Awareness and adoption of fetal surgery for spina bifida remain limited in Chile.
Purpose of the Study:
- To review current evidence on fetal surgery for spina bifida.
- To evaluate clinical outcomes associated with fetal surgery.
- To assess the applicability of fetal surgery within the Chilean healthcare system.
Main Methods:
- A narrative literature review was conducted.
- Searches included original articles, reviews, and clinical guidelines.
- Databases searched were PubMed, Web of Science, and SciELO using relevant keywords.
Main Results:
- Fetal surgery for spina bifida demonstrates superior outcomes compared to postnatal management.
- Key benefits include reduced need for ventriculoperitoneal shunting and enhanced motor function.
- Chile faces implementation challenges, such as limited access to multidisciplinary teams and funding.
Conclusions:
- Fetal surgery for spina bifida should be considered the gold standard for eligible fetuses.
- Chilean health authorities must prioritize equitable access to this life-improving therapy.
- Ensuring availability in public and private sectors upholds a fundamental right and enhances quality of life.
Abstract:
Fetal surgery for open spina bifida is the treatment of choice for fetuses with this malformation. However, 14 years after its global implementation, its recognition in Chile remains limited, even among specialists such as obstetrician-gynecologists, neonatologists, and neurosurgeons.
Objective:
To synthesize current evidence on fetal surgery for spina bifida, its clinical outcomes, and applicability in the national context.
Methods:
Narrative literature review based on a non-systematic search of original articles, reviews, and clinical guidelines in academic databases (PubMed, Web of Science, SciELO), using key terms related to in utero/fetal surgery for spina bifida.
Results:
Fetal surgery for spina bifida showed significant benefits over postnatal management by reducing the need for ventriculoperito- neal shunting and improving motor function. In Chile, despite existing experience, implementation barriers persist, including limited access to specialized multidisciplinary teams and adequate funding.
Conclusions:
Fetal surgery for spina bifida should be considered the gold standard for eligible fetuses. Health authorities must ensure its availability in both public and private healthcare systems, guaranteeing the fundamental right of access to this therapy, which improves the quality of life of patients, their families, and society.
