Subjects:
Focus on Subspecialties, Neurological Surgery
Topics:
fetal surgery, meningomyelocele

More than three years have passed since publication of the results of the Management of Myelomeningocele Study (MOMS), which compared fetal surgery to repair the spinal lesion with standard postnatal repair (

Adzick
 
NS
, et al 
N Engl J Med
 
2011
;
364
:
993
-1004
). The principal findings were positive, with children who had undergone prenatal repair having improved outcomes in several areas at 30 months follow-up.

The specific areas of benefit were a decreased need for ventricular shunts, improved overall motor function and a higher rate of independent ambulation by 30 months. Of note, there was no evidence of a difference in cognitive outcomes or urological outcomes. One of the major concerns raised at the time of the study (which is outlined in an editorial that accompanies the report in NEJM) was that 79% of the children in the fetal surgery group had preterm deliveries,...

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