title: Fetal surgery for neural tube defects.
abstract: Open spina bifida remains a major source of disability despite an overall decrease in incidence. It is frequently diagnosed prenatally and can thus - potentially - be treated by fetal surgery. Animal studies and preliminary human studies strongly suggest that at least a portion of the neurological abnormalities seen in these patients are secondary, and occur in mid-gestation. It is estimated that approximately 400 fetal operations have now been performed for myelomeningocele world wide. Despite this large experience, the technique remains of unproven benefit. Preliminary results suggest that fetal surgery results in reversal of hindbrain herniation (the Chiari II malformation), a decrease in shunt-dependent hydrocephalus, and possibly improvement in leg function, but these findings might be explained by selection bias and changing management indications. A randomized prospective trial (the MOMS trial) is currently being conducted by three centers in the United States, and is estimated to be completed in 2009.
authors: Department of Neurosurgery, Children's Hospital of Philadelphia, 6th Floor Wood Bldg, 34th St. and Civic Center Blvd., Philadelphia, PA 19104, USA. sutton@email.chop.edu
authors: Leslie N
authors: LN
authors: Sutton
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D046128:Fetal Therapies / Q000379:methods*; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000601:surgery; D008591:Meningomyelocele / Q000175:diagnosis / Q000601:surgery; D009436:Neural Tube Defects / Q000175:diagnosis / Q000601:surgery*; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods; D016032:Randomized Controlled Trials as Topic
references: JAMA. 1999 Nov 17;282(19):1819-25
references: 10573272
references: J Pediatr Surg. 2006 Jun;41(6):1125-9
references: 16769346
references: Pediatr Neurosurg. 2000 Nov;33(5):252-256
references: 11155062
references: JAMA. 2001 Jun 20;285(23):2981-6
references: 11410096
references: J Pediatr Surg. 2001 Nov;36(11):1666-71
references: 11685698
references: Paediatr Perinat Epidemiol. 2001 Oct;15(4):374-8
references: 11703686
references: Am J Obstet Gynecol. 2001 Nov;185(5):1052-8
references: 11717632
references: Eur J Pediatr Surg. 2001 Dec;11 Suppl 1:S18-20
references: 11813128
references: Pediatrics. 2002 Mar;109(3):409-13
references: 11875133
references: J Pediatr Surg. 2002 Mar;37(3):488-92
references: 11877673
references: Neurosurgery. 2002 May;50(5):1152-4; discussion 1154-5
references: 11950422
references: Teratology. 2002 Jul;66(1):33-9
references: 12115778
references: N Engl J Med. 2002 Jul 25;347(4):256-9
references: 12140301
references: Childs Nerv Syst. 2002 Jul;18(6-7):361-3
references: 12172948
references: Pediatr Neurosurg. 2003 Jan;38(1):27-33
references: 12476024
references: Pediatr Neurosurg. 2003 Mar;38(3):128-32
references: 12601237
references: J Pediatr Surg. 2003 Mar;38(3):451-8; discussion 451-8
references: 12632366
references: Pediatr Neurosurg. 2003 Jul;39(2):81-90
references: 12845198
references: Childs Nerv Syst. 2003 Aug;19(7-8):596-9
references: 12905004
references: Semin Pediatr Surg. 2003 Aug;12(3):196-201
references: 12961114
references: Pediatr Neurosurg. 2003 Nov;39(5):234-9
references: 14512686
references: Am J Obstet Gynecol. 2003 Aug;189(2):482-7
references: 14520222
references: Br J Gen Pract. 2003 Aug;53(493):632-6
references: 14601340
references: Pediatr Surg Int. 2004 Jan;20(1):14-8
references: 14689212
references: Circulation. 2004 Sep 21;110(12):1549-56
references: 15353490
references: J Neurosurg. 1978 Nov;49(5):711-24
references: 712393
references: Z Kinderchir. 1984 Aug;39(4):259-61
references: 6388186
references: Lancet. 1986 Apr 19;1(8486):917-8
references: 2870386
references: J Urol. 1993 Dec;150(6):1879-83
references: 8230524
references: Inquiry. 1994 Summer;31(2):188-205
references: 8021024
references: Nat Med. 1995 Apr;1(4):342-7
references: 7585064
references: Am J Obstet Gynecol. 1997 Jan;176(1 Pt 1):256-7
references: 9024126
references: Pediatr Pathol Lab Med. 1996 Sep-Oct;16(5):701-12
references: 9025869
references: J Pediatr Surg. 1997 Mar;32(3):448-52
references: 9094015
references: Early Hum Dev. 1997 Nov 24;50(1):27-37
references: 9467691
references: Pediatr Neurosurg. 1997 Oct;27(4):190-3
references: 9577972
references: Fetal Diagn Ther. 2007;22(1):1-6
references: 17003546
references: J Neurosurg. 2007 Feb;106(2 Suppl):106-10
references: 17330535
references: J Neurosurg. 2007 Mar;106(3 Suppl):213-21
references: 17465388
references: Issues Law Med. 1998 Spring;13(4):447-58
references: 9594455
references: Pediatr Neurosurg. 1998 Apr;28(4):177-80
references: 9732243
references: Lancet. 1998 Nov 21;352(9141):1675-6
references: 9853442
references: N Engl J Med. 1999 Aug 26;341(9):660-6
references: 10460818
references: Plast Reconstr Surg. 2005 Jan;115(1):204-12
references: 15622252
references: Fetal Diagn Ther. 2005 Jul-Aug;20(4):316-20
references: 15980648
references: Fetal Diagn Ther. 2005 Sep-Oct;20(5):437-41
references: 16113568
references: JAMA. 2005 Aug 24;294(8):947-54
references: 16118385
references: Fetal Diagn Ther. 2006;21(2):185-93
references: 16491001
references: Radiology. 2006 Mar;238(3):997-1003
references: 16505396
references: Pediatrics. 2006 Mar;117(3):803-13
references: 16510661
references: Neurosurgery. 2006 Apr;58(4 Suppl 2):ONS-E376; discussion ONS-E376
references: 16575293
references: Am J Obstet Gynecol. 2006 Apr;194(4):1145-50; discussion 1150-2
references: 16580316
references: JAMA. 1999 Nov 17;282(19):1826-31
references: 10573273