title: Prenatal surgery for myelomeningocele.
abstract: OBJECTIVE
  This review summarizes outcomes of fetal surgery for myelomeningocele (MMC) as they compare to postnatal MMC repair and provides insights into areas of investigation to improve fetal MMC repair.
  
  
  RESULTS
  Recent studies confirm the findings of the Management of Myelomeningocele Study and support the decreased need for postnatal ventricular shunts, improved hindbrain herniation, and improved neurofunctional outcome following open fetal repair compared to postnatal repair at the risk of increased maternal complications and preterm birth. Larger studies of minimally invasive fetal repair demonstrate that, although technically feasible, this approach is associated with longer operative times, increased membrane complications, an earlier gestational age at birth, persistent cerebrospinal fluid leakage, and incidences of persistent postnatal hindbrain herniation resulting in death or requiring surgical decompression.
  
  
  CONCLUSIONS
  Open prenatal MMC repair is a new standard of care option with improved postnatal outcomes in a highly specific patient population when performed at select multidisciplinary fetal surgery centers. More investigations are required to optimize minimally invasive approaches prior to reliable clinical application.
authors: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
authors: William H
authors: WH
authors: Peranteau
authors: N Scott
authors: NS
authors: Adzick
mesh_terms: D000818:Animals; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D046128:Fetal Therapies / Q000379:methods; D005332:Fetoscopy; D005333:Fetus / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D008591:Meningomyelocele / Q000601:surgery*; D011247:Pregnancy; D016896:Treatment Outcome