Paper

Fetal Spina Bifida Repair - Current Trends and Prospects of Intrauterine Neurosurgery
M.A. Fichter^a, U. Dornseifer^b, J. Henke^c, K.T.M. Schneider^d, L. Kovacs^a, E. Biemer^a, J. Bruner^e, N.S. Adzick^f, M.R. Harrison^g, N.A. Papadopulos<sup>a

a</sup>Department of Plastic and Reconstructive Surgery, Technical University of Munich,
^bDepartment of Plastic and Reconstructive Surgery, Hand Surgery and Burn Center, Klinikum Bogenhausen, Technical University of Munich,
^cInstitute of Experimental Oncology and Therapy Research, and
^dSection of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University of Munich, Munich, Germany;
^fCenter for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pa.,
^eDepartments of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tenn., and
^gDepartments of Surgery and Fetal Treatment Center, University of California, San Francisco, Calif., USA

Address of Corresponding Author

Fetal Diagn Ther 2008;23:271-286 (DOI: 10.1159/000123614)

  Key Words

• Myelomeningocele
• Fetal surgery
• Spina bifida
• Open neural tube defects
• Dysraphic syndromes

  Abstract

Myelomeningocele is a common dysraphic defect leading to severe impairment throughout the patient's lifetime. Although surgical closure of this anomaly is usually performed in the early postnatal period, an estimated 330 cases of intrauterine repair have been performed in a few specialized centers worldwide. It was hoped prenatal intervention would improve the prognosis of affected patients, and preliminary findings suggest a reduced incidence of shunt-dependent hydrocephalus, as well as an improvement in hindbrain herniation. However, the expectations for improved neurological outcome have not been fulfilled and not all patients benefit from fetal surgery in the same way. Therefore, a multicenter randomized controlled trial was initiated in the USA to compare intrauterine with conventional postnatal care, in order to establish the procedure-related benefits and risks. The primary study endpoints include the need for shunt at 1 year of age, and fetal and infant mortality. No data from the trial will be published before the final analysis has been completed in 2008, and until then, the number of centers offering intrauterine MMC repair in the USA is limited to 3 in order to prevent the uncontrolled proliferation of new centers offering this procedure. In future, refined, risk-reduced surgical techniques and new treatment options for preterm labor and preterm rupture of the membranes are likely to reduce associated maternal and fetal risks and improve outcome, but further research will be needed.

Copyright © 2008 S. Karger AG, Basel

  Author Contacts

Nikolaos A. Papadopulos, MD
Department of Plastic and Reconstructive Surgery, Klinikum rechts der Isar
Technical University of Munich
Ismaninger Strasse 22, DE-81675 Munich (Germany)
Tel. +49 89 4140 2171, Fax +49 89 4140 4869, E-Mail n.papadopulos@lrz.tum.de

  Article Information

Received: December 20, 2005
Accepted after revision: January 24, 2007
Published online: April 14, 2008
Number of Print Pages : 16
Number of Figures : 5, Number of Tables : 0, Number of References : 160