title: Fetal surgery for myelomeningocele: history, research, clinical trials, and future directions.
abstract: Myelomeningocele, more commonly known as spina bifida, is the most common neural tube defect worldwide. In the United States, it is the primary cause of lifelong childhood paralysis with approximately four children born daily with this devastating disease. To minimize damage to the exposed spinal cord and prevent ascending central nervous system infections, postnatal closure of the spinal defect has been the standard of care for decades. Research into the mechanism of spinal cord injury in those with spina bifida revealed that damage continues to accrue during the gestational period. Prenatal defect closure via in utero surgery was proposed to prevent this early deterioration of the spinal cord, and early animal research demonstrated that prenatal repair was feasible and promising. This paved the way for the first human prenatal repairs in the mid-to-late 1990s. Following the promising outcomes observed during the first human cases, a randomized controlled trial, the Management of Myelomeningocele Study (MOMS), was conducted comparing postnatal repair of spina bifida to prenatal repair. The MOMS trial demonstrated that to those undergoing prenatal repair of spina bifida had a decreased need for ventriculoperitoneal shunting and improved lower extremity motor function. With the success of the MOMS trial, in utero repair is now considered the standard of care in those who meet the criteria for prenatal repair. This review will provide an overview of spina bifida and its impact, highlight the historical changes in care, describe the early research and theory that made prenatal repair an option, discuss the clinical experiences with human fetal repair and briefly touch on future research directions for those with myelomeningocele.
authors.affiliation: University of California, Davis Health System, Sacramento, CA, USA - benjamin.keller@ucdmc.ucdavis.edu.
authors.forename: B A
authors.initials: BA
authors.lastname: Keller
authors.forename: D L
authors.initials: DL
authors.lastname: Farmer
mesh_terms: D000818:Animals; D005260:Female; D005315:Fetal Diseases / Q000503:physiopathology / Q000601:surgery*; D046128:Fetal Therapies / Q000379:methods*; D006801:Humans; D008591:Meningomyelocele / Q000503:physiopathology / Q000601:surgery*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods; D016896:Treatment Outcome