Fetal surgery for myelomeningocele

Myelomeningocele is a common birth defect that is associated with significant lifelong morbidity. Despite improvements in technology and overall patient care, little progress has been made in the postnatal surgical management of the child with spina bifida. Postnatal surgery is aimed at covering the exposed spinal cord and preventing infection. Numerous interventions for ventricular shunts, tethered cord, scoliosis, incontinence, urologic complications, and extremity anomalies are frequently required. Although myelomeningocele is a nonlethal fetal anomaly, the limitations with current postnatal treatment strategies has led to extensive investigation of prenatal treatment options. This article outlines the rationale for fetal intervention and discusses the preliminary experience with human fetal myelomeningocele surgery.