Outcome of Therapies for Fetal Myelomeningocele

Outcome after surgery

• Shunted hydrocephalus halved: Relative to postnatal closure, fetal myelomeningocele repair is associated with a nearly 50% reduction in the need for a CSF shunt (82% vs 40%) (1).
• Improved development: At age 30 months, children who underwent fetal myelomeningocele repair surgery show better scores on motor scales and have motor level improvement relative to children whose myelomeningocele repair was performed postnatally (5).
• Increased risk of tethered spinal cord: Low-level evidence suggests there may be a greater risk of symptomatic tethered spinal cord among patients undergoing intrauterine closure (4); most cases of tethered spinal cord are related to the coexistence of a dermoid or epidermoid lesion. The role of multilayer closure and/or dural patching on tethered spinal cord is under active investigation.
• Long-term outcomes: Long-term outcome data for fetal myelomeningocele repair are limited and emerge from the two longest-operating centers for fetal myelomeningocele repair: the Fetal Center at Vanderbilt and the Children’s Hospital of Philadelphia. Preliminary evidence suggests that most patients who have undergone in-utero closure of their myelomeningoceles are community ambulators at adolescence. Relative to postnatally treated patients, they score higher on quality-of-life assessments (5,6).