Open Fetal Myelomeningocele Repair at the Zurich Center for Fetal Diagnosis and Therapy

Background: The recently published MOMS Trial compared prenatal versus postnatal repair of myelomeningocele (MMC) and provided evidence that fetal surgery is the new therapeutic standard for selected fetuses with this devastating malformation. Based on these data, a Fetal Surgery Program for open fetal spina bifida repair was started at our center in 2010. This paper reports our experience with the first 9 cases.

Patients and methods: The guidelines set forth by the MOMS-Trial protocol were strictly adopted. All open fetal surgeries were carried out in close collaboration with our partners from the Children's Hospital of Philadelphia. Operative procedures and all pre- and postoperative management regimens were basically identical with the ones used in Philadelphia. Pertinent data were collected prospectively.

Results: Between December 2010 and May 2013, 9 open fetal MMC surgeries were performed (mean operation time 127 ± 22 min). All 9 fetuses showed reversal of hindbrain herniation within 4 weeks postoperatively. As of today, 8 babies were born via Cesarian section that was performed between 34+6 and 37+3 weeks of gestation (median 36+4 weeks). One baby died postnatally due to lung hypoplasia and respiratory failure. In 2 babies, a ventriculoperitoneal shunt was placed at age 2 and 7 months. Lower extremity function was better than predicted in all 7 babies. 3 babies demonstrated normal bladder manometry. Maternal safety was preserved in all mothers.

Conclusion: Our preliminary findings are very similar to the benchmark data generated by the MOMS-Trial and thus further support the view that selected fetuses with MMC may benefit substantially from repair before birth.