In utero repair for spina bifida proves beneficial. (Ongoing Study of a Series of 43 Cases).

NEW ORLEANS -- Fetal repair of myelomeningocele shows promise as a possible means of alleviating the devastating neurologic and orthopedic complications of spina bifida.

The findings of a series of 43 cases of myelomeningocele repair undertaken at the Children's Hospital of Philadelphia suggest that in utero surgery "leads to decreased need for ventriculoperitoneal shunting, leads to the slowing or arrest of progressive ventriculomegaly, and results in consistent resolution of hindbrain herniation," the hospital's Dr. Mark Johnson said at the annual meeting of the Society for Maternal-Fetal Medicine.

Fetuses included in the study all had thoracic to S1 level defects, normal leg movement without evidence of foot abnormalities, and Arnold-Chiari hindbrain herniation. Ventriculomegaly of less than 17 mm also was required.

Neonatal survival thus far is 93%. Mean gestational age at delivery was 33 weeks plus 4 days, and mean birth weight was 2,395 g. Mean Apgar scores were 7.5 and 8.8 at 1 and 5 minutes, respectively.

Delivery is by elective cesarean section following documentation of fetal lung maturity at 36 weeks.

Three women have yet to deliver, he said.

Mean ventriculomegaly at time of delivery was 15.7 mm. All 40 of the surviving fetuses were found to have reversal of the Arnold-Chiari hindbrain herniation confirmed on a 6-week postoperative MRI.