The rationale for in utero repair of myelomeningocele

Objectives: Despite advances in prenatal diagnosis, management of fetal mye lomeningocele has been limited to abortion or supportive postnatal care. Th e rationale for fetal repair of myelomeningocele and initial clinical outco mes are discussed. Methods: A complete review of the literature concerning fetal myelomeningocele and repair was performed. Results: While myelomening ocele is a primary embryologic disorder, neurologic damage is also secondar y to progressive in utero damage to the exposed spinal cord. Animal models with midgestational coverage of the spinal defect demonstrate near normal n eurologic function at term. Early clinical results suggest that fetal closu re can salvage neurologic function, reverse hindbrain herniation, and dimin ish the need for ventriculoperitoneal shunting. Conclusions: In utero repai r of myelomeningocele may improve neurologic outcomes and reduce hindbrain herniation in selected patients. Copyright (C) 2001 S.Karger AG, Basel.