Management of Myelomeningocele Study (MOMS) reports that in utero myelomeningocele closure is associated with lower ventricular shunting rates and higher ambulation rate, but with a higher rate of chorioamnion separation, premature rupture of membranes, and preterm delivery compared to conventional closure. To reduce these pregnancy complications, Bennett et al describe a prospective cohort study comparing the MOMS prenatal cohort with a study cohort of 43 consecutive patients undergoing fetal myelomeningocele closure at one institution using a new surgical technique for uterine entry and closure, designed to minimize separation of the amniotic membrane. Statistically significant decrease in premature membrane rupture from 46% to 22%, decrease in chorioamnion separation from 26% to 0, and increase in infants born at 37 weeks or later (21% to 39%) were observed. This study shows potential for technical improvements to decrease fetal surgery complications and realize the benefits of in utero myelomeningocele closure.
Journal of Neurosurgery Pediatrics