Fetal Surgery in Zurich: Key Features of Our First Open in utero Repair of Myelomeningocele

Introduction

The first description of apparently secondary, that is, in utero acquired, damage to the pathologically exposed spinal cord within the myelomeningocele (MMC) lesion dates back to 1956.[1] For obvious reasons, the significance of this observation regarding therapeutic consequences was not recognized until fetal surgery became a reality in the 1980s.[2] Only then was the hypothesis born that early in utero intervention might stop the ongoing neural tissue destruction and so reduce the neurologic deficit otherwise seen at birth.[3]

Compelling experimental[4] [5] as well as preliminary clinical[6] [7] [8] [9] [10] evidence collected over the past two decades have led to the conclusion that fetal surgery for MMC may be an effective novel therapy to ameliorate the neurologic outcome. Lastly, a recently published prospective, controlled, and randomized study (Management of Myelomeningocele Study [MOMS] Trial)[11] has, for the very first time, generated sound data showing that in utero repair can be recommended as a novel standard of care for selected fetuses with MMC. This is a report on the first fetus with MMC operated under the published criteria, principles, and procedures set forth by the MOMS Trial at the Zurich Center for Fetal Diagnosis and Therapy.

• References

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