Fetal surgery for neural tube defects

Abstract

A recently completed randomized, controlled, prospective multicenter trial, the Management of Myelomeningocele Study (MOMS), demonstrated that maternal-fetal surgery for myelomeningocele (MMC) before 26 weeks of gestation decreases the need for ventriculoperitoneal shunting, decreases hindbrain herniation, and preserves neurological function. However, the study also found that fetal MMC surgery is not without significant risks, such as premature delivery or maternal complications. The primary objective of this review is to provide a critical overview of the rationale for in-utero intervention for MMC in the context of pathological observations, animal models, initial clinical experience with human fetal MMC surgery, and the results of the randomized trial. The secondary objective is to briefly discuss our approach to fetal MMC. Finally, the ongoing clinical research and the recent developments of potential alternative fetal surgical techniques will be highlighted.

Keywords: Fetal surgery; Hindbrain herniation; Hydrocephalus; Myelomeningocele; Prenatal diagnosis; Spina bifida.