The first 12 Open Fetal Myelomeningocele (MMC) Repairs in Germany

Background:

Open fetal surgery (OFS) for myelomeningocele repair has made significant progress and can now be offered in many countries all over the world. Since 2016 an interdisciplinary team of the university hospital Heidelberg with initial support from the colleagues of St. Louis established this treatment in Germany. Our experiences are presented and discussed.

Patients and Methods:

All patients were evaluated interdisciplinary prenatal according to a standardized protocol. Sacral lesions were excluded. The surgical technique was similar described in the MOMS study. All pregnant women received a fetal MRI preoperatively.

Results:

OFS was performed between the 24th and 25th week of gestation (GA). The lesion level was 5xL4/5, 5xL3/4, 2xL5/S1. The repair was successful in all 12 cases without cerebrospinal fluid (CSF) leakage and reversible hindbrain herniation (case 12 is still intrauterine). No fetal or maternal death. Average time of delivery was 34+8 GA, 2 preterm< 31GA; average birth weight 2360 g. Maternal complications: 2 uterus dehiscence and 1 oligohydramnios. 3 children needed ventricular-peritoneal shunting. Improvement of motor function was seen 9 patients.

Conclusion:

The open fetal repair of MMC in selected fetuses could offer the unborn child a better quality of life but could not cure the defect and is neither free of risks nor complications. This has to be taken into consideration in relation to the maternal and fetal risks. A collaboration of the pediatric community is recommended to collect all these data in a common register to develop standardized treatment and follow up.

Key Words: Open fetal surgery, myelomeningocele repair, hind brain herniation