Update on open fetal myelomeningocele repair at the Zurich center for fetal diagnosis and therapy

Background: Since the published MOMS Trial data, fetal surgery is the new therapeutic standard for selected fetuses with this devastating malformation. Based on this evidence, a Fetal Surgery Program for open fetal spina bifida repair was started in Zurich in 2010. This paper reports our experience with the first 11 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 January 2014, 11 open fetal MMC repairs were performed (mean operation time 127 ± 19 min). All 11 fetuses showed reversal of hindbrain herniation within 4 weeks postoperatively. All babies were born via Cesarian section that was performed between 33+6 and 37+3 weeks of gestation (median 36+1 weeks). One baby died postnatally due to lung hypoplasia and respiratory failure. In 3 babies, a ventriculoperitoneal shunt was placed at the age of 2, 3 and 7 months. Lower extremity function was better than predicted in all 11 babies. 3 babies demonstrated normal bladder manometry. Maternal safety was preserved in all mothers.

Conclusion: Our 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.