Slovenská chirurgia 1-2e/2024

Current approaches in fetal meningomyelocele surgery

Meningomyelocele (MMC) is the most common form of neural tube defects with an incidence of approximately 0.2 to 0.4 per 1,000 live births. For a long time, postnatal surgery was the only treatment option. This surgical procedure remains the standard today, but prenatal options are also emerging. Fetal surgery is a relatively new field of medicine that is constantly evolving. The Myelomeningocele Management Study (MOMS) published in 2011 proved that prenatal surgery for MMC significantly improved the prognosis by decreasing patient´s risk of death or need for shunting by 12 months of age, reducing the degree of Chiari II malformation and improving motor function compared with postnatal surgery. However, prenatal NTD correction may not be fundamentally better than postnatal, it also carries certain risks. The purpose of this work is to present an overview of the development of fetal MMC surgery, to bring closer the individual surgical approaches, the differences between them, and to point out the current controversies.

Keywords: fetal surgery for meningomyelocele, microneurosurgery, laparotomy, laparoscopy, fetoscopic approach