Fetal myelomeningocele repair: short-term clinical outcomes

Am J Obstet Gynecol. 2003 Aug;189(2):482-7. doi: 10.1067/s0002-9378(03)00295-3.


Objective: The study was undertaken to evaluate short-term clinical outcomes with antenatal myelomeningocele (MMC) repair.

Study design: Retrospective review of 50 fetuses that underwent open fetal MMC closure was performed. Inclusion criteria included less than 26 weeks' gestation, thoracic to S1 level defect, absent clubfoot deformity, Arnold-Chiari malformation, ventriculomegaly less than 17 mm, normal karyotype, and no other anomalies.

Results: Perinatal survival was 94% (47/50 fetuses). Mean age at delivery was 34 weeks 3 days. All fetuses demonstrated reversal of hindbrain herniation. Forty-three percent of the 50 fetuses have required ventriculoperitoneal shunting compared with 100% thoracic, 88% lumbar, and 68% sacral (85% overall) in 297 historic controls. Better-than-predicted leg function was seen in 57% of thoracic and lumbar level lesion patients.

Conclusion: Early experience with fetal MMC repair suggests a decreased need for ventriculoperitoneal shunting, arrest or slowing of progressive ventriculomegaly, and consistent resolution of hindbrain herniation. However, further long-term follow-up is needed to evaluate neurodevelopment and bladder and bowel function.

MeSH terms

  • Adult
  • Delivery, Obstetric
  • Female
  • Fetal Diseases / physiopathology
  • Fetal Diseases / surgery*
  • Gestational Age
  • Humans
  • Infant Mortality
  • Infant, Newborn
  • Leg / physiopathology
  • Lumbosacral Region
  • Meningomyelocele / embryology*
  • Meningomyelocele / physiopathology
  • Meningomyelocele / surgery*
  • Pregnancy
  • Pregnancy Outcome
  • Reoperation
  • Retrospective Studies
  • Survival Analysis
  • Thorax
  • Time Factors
  • Treatment Outcome
  • Ventriculoperitoneal Shunt