Fetal surgical intervention for myelomeningocele: lessons learned, outcomes, and future implications.
Enrico DanzerLuc JoyeuxAlan W FlakeJan DeprestPublished in: Developmental medicine and child neurology (2019)
Fetal myelomeningocele (fMMC) closure (spina bifida aperta) has become a care option for patients that meet inclusion criteria, but it is clear that fetal intervention, while improving outcomes, is not a cure. This review will: (1) focus on the rationale for fMMC surgery based on preclinical studies and observations that laid the foundation for human pilot studies and a randomized controlled trial; (2) summarize important clinical outcomes; (3) discuss the feasibility, efficacy, and safety of recent developments in fetal surgical techniques and approaches; and (4) highlight future research directions. Given the increased risk of maternal and fetal morbidity associated with prenatal intervention, accompanied by the increasing number of centres performing interventions worldwide, teams involved in the care of these patients need to proceed with caution to maintain technical expertise, competency, and patient safety. Ongoing assessment of durability of the benefits of fMMC surgery, as well as additional refinement of patient selection criteria and counselling, is needed to further improve outcomes and reduce the risks to the mother and fetus. WHAT THIS PAPER ADDS: High-quality prospective studies are needed to broaden the indication for fetal surgery in the general myelomeningocele population. Innovative minimally invasive approaches have had promising results, yet lack comprehensive and robust experimental or clinical evaluation. Important information to help families make informed decisions regarding fetal surgery for myelomeningocele is provided.
Keyphrases
- minimally invasive
- patient safety
- coronary artery bypass
- end stage renal disease
- randomized controlled trial
- healthcare
- newly diagnosed
- quality improvement
- ejection fraction
- clinical evaluation
- peritoneal dialysis
- chronic kidney disease
- palliative care
- surgical site infection
- physical activity
- current status
- stem cells
- clinical trial
- type diabetes
- robot assisted
- case report
- metabolic syndrome
- pain management
- acute coronary syndrome
- social media
- human immunodeficiency virus
- patient reported
- hepatitis c virus
- study protocol
- smoking cessation
- men who have sex with men