Fetal surgery for myelomeningocele: current clinical practice and translational research.

Abstract

The Management of Myelomeningocele Study (MOMS) showed that prenatal repair of myelomeningocele (MMC) resulted in better neurological outcomes than postnatal closure but was, by necessity, associated with higher rates of obstetrical complications. Fetoscopic MMC repair has been explored as an alternative to reduce complications of the open approach used in MOMS. This review summarizes the trends in fetoscopic and open fetal repair of MMC. We searched PubMed and Embase® for studies on fetal repair of MMC published since the completion of the MOMS trial. Fetoscopic MMC repair was temporarily halted in the United States (US) prior to the initiation of the MOMS trial. The German Center for Fetal Surgery has reported the largest series of fetoscopic MMC repair. The other largest series is the Brazilian Cirurgia Endoscopica para Correcao Antenatal da Meningomielocele (CECAM) trial. Both groups demonstrate the feasibility of minimally invasive fetal MMC repair, but also report high rates of premature rupture of membranes, preterm births, and persistent cerebrospinal fluid (CSF) leakage that requires postnatal revision of the MMC repair. In addition, these groups have yet to report long term cognitive, behavioral, and functional outcomes of fetoscopic MMC repair. The fetoscopic approach to fetal MMC repair is a promising alternative to the open approach if preterm birth and persistent CSF leakage can be overcome.