Fetal surgery called promising for spina bifida.(Improves Short-Term Outcomes)

LISBON -- In utero surgery for spina bifida is a risky but promising procedure that appears to improve short-term outcomes, and now, thanks to a recently initiated multicenter trial, long-term results are being evaluated as well.

The Management of Myelomeningocele Study (MOMS) is a randomized controlled trial sponsored by the National Institute of Child Health and Human Development. Recruitment began in the spring of this year with a goal

of enrolling 200 women to undergo care at one of three clinical centers participating in the trial. Outcomes will be evaluated at 12 and 30 months, Dr. Joseph Bruner said at a world congress sponsored by the Fetal Medicine Foundation.

To date, more than 250 surgeries to repair the lesions associated with spina bifida have been performed at centers such as Children's Hospital of Philadelphia, the University of California, San Francisco, and Vanderbilt University in Nashville, Tenn., he said.

In utero repair appears to have several advantages over postnatal surgery, including potentially fewer urinary infections, less gastrointestinal reflux, improved fetal leg function and cognitive development, and less need for shunt placement with careful patient selection, said Dr. Bruner, professor of obstetrics and gynecology at Vanderbilt.

To date, 180 in utero repairs of myelomeningoceles, which comprise about 80% of lesions, and myeloschises, which comprise the remaining 20% of lesions, have been performed at Vanderbilt. Surgeons there first attempted the procedure in 1994 using a laparoscopic approach that proved less than ideal and switched to an open approach in 1997.

To qualify for surgery, the fetus must have a normal karyotype and no other major malformations, and the parents must be fully informed about the potential risks, which include fetal death.