Some babies who are diagnosed with myelomeningocele during pregnancy may undergo prenatal myelomeningocele surgery to repair the spinal defect.
In fact, results from a seven-year clinical research study called “Management of Myelomeningocele Study (MOMS)” showed that babies who received prenatal repair of myelomeningocele can significantly benefit. The study, published in 2011, compared the effects of fetal surgery vs. surgical repair after birth. It followed 183 women and found that if a baby is operated on while still in the womb, some serious complications of myelomeningocele can be lessened.
MOMS showed that babies who had fetal surgery for myelomeningocele are less likely to suffer from hydrocephalus, a fluid collection in the brain. Babies who are born with hydrocephalus usually need ventriculoperitoneal (VP) shunting, which involves surgically implanting a thin, hollow tube with a valve underneath the skin, behind the ear, that drains excess fluid from the brain into the belly or chest area. In MOMS, 40 percent of babies who had fetal surgery for myelomeningocele needed a VP shunt, while 82 percent of babies who had surgery after they were born needed a VP shunt.
Another finding in the study is that 42 percent of the children who had fetal surgery were able to walk without crutches by age 2½. Only 21 percent of babies who had surgery after birth were able to walk unassisted at that age.
However, all this potential benefit comes at a cost that only the mothers can bear. She must go through extensive surgery, which requires Cesarean deliveries for future pregnancies and a risk for uterine rupture during the current pregnancy. This needs to be discussed with your doctors.
These and other results of MOMS are promising, and physicians are cautiously optimistic. Follow-up studies are under way to assess the long-term effect of prenatal myelomeningocele repair vs. surgery after birth.