[In utero treatment of spina bifida]

Dysraphisms are characterized by an anomalie of the vertebrae and spinal cord. Only the prevalence of open dysraphisms is known, which in France is around 5 per 10,000 pregnancies. The prenatal diagnosis rate for open dysraphisms exceeds 95% in France, with a high rate of termination of pregnancy, close to 90%. Open dysraphisms (myelomeningocele and myeloschisis) represent the most severe forms and are associated with lower limb paralysis (the severity of which depends on the level of the defect), urinary sphincter incontinence (neurogenic bladder), and fecal incontinence, making a request for pregnancy termination admissible. However, the possibility of performing fetal repair surgery, which has been available in France since 2014, must now be included in prenatal prognostic information. While this surgery does not eliminate disabilities, its goal is to "protect" the fetal brain by stopping the leakage of cerebrospinal fluid, thus helping to correct/limit type II Chiari malformation. This, in turn, helps reduce secondary ventriculomegaly, decreases the need for postnatal ventriculoperitoneal shunting, and ultimately improves motor function.