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Speciality Spotlight
Congential Malformation
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Endoscopic Coverage of Fetal Myelomeningocele in Utero
Bruner JP, Richards WO, Tulipan NB, et al (Vanderbilt Univ, Nashville, Tenn)
Am J Obstet Gynecol 180 : 153 – 158, 1999
Background – Myelomeningocele is the most common congenital CNS malformation. Currently, however, management options are limited to termination or neonatal therapy. The role of minimally invasive in utero surgery for myelomeningocele coverage was investigated.
The procedure was offered to women in the middle of their second trimester of a pregnancy complicated by fetal myelomeningocele. Four fetuses were treated by maternal split-thickness skin graft over the exposed spinal cord or neural elements.
Conclusion : Minimally invasive fetal surgery appears to be a viable option in the treatment of nonlethal fetal malformations that result in progressive, disabling organ damage. Two of the 4 fetuses undergoing in utero surgery for myelomeningocele coverage in this study are alive with mild deficits at 6 months and 3 years of age.
Editorial comments : This experience offers a potential valuable alternative to abortion or a possible life of immobility and incontinence while injury continues during pregnancy without fetal intervention.
