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Child's Nervous System

, Volume 33, Issue 7, pp 1185–1190 | Cite as

New directions in fetal surgery for myelomeningocele

  • Sandra K. KabagambeEmail author
  • Y. Julia Chen
  • Melissa A. Vanover
  • Payam Saadai
  • Diana L. Farmer
Focus Session

Abstract

The treatment of children with myelomeningocele (MMC) has improved over time, from supportive management to early postnatal closure to prenatal repair of the defect. The Management of Myelomeningocele Study (MOMS) showed that prenatal repair of MMC resulted in improved neurological outcomes compared to postnatal closure. Follow-up studies showed that prenatal repair was, as with any other fetal intervention, associated with higher rates of obstetrical complications. There was no significant difference in urological outcomes. Long-term follow-up of ambulatory status, executive functioning, and urological outcomes is needed to determine the durable effects of fetal MMC repair on mobility, functional independence, and the prevalence of renal insufficiency in patients with MMC who survive to adulthood. The future of fetal MMC repair consists of developing strategies to reduce maternal morbidity and improve infant outcomes. Fetoscopic MMC repair has been suggested as an alternative to open repair that may reduce obstetrical complications and the need for cesarean delivery in subsequent pregnancies. Translational research using mesenchymal stromal cells to augment fetal repair of ovine MMC has shown improvement in motor function.

Keywords

Myelomeningocele Prenatal repair Fetal surgery Fetoscopic 

Notes

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest.

Funding

This study was not funded.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Sandra K. Kabagambe
    • 1
    Email author
  • Y. Julia Chen
    • 1
  • Melissa A. Vanover
    • 1
  • Payam Saadai
    • 1
  • Diana L. Farmer
    • 1
  1. 1.Department of SurgeryUniversity of California, Davis Health SystemsSacramentoUSA

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