February 3, 2020Pediatrics
Myelomeningocele, the most serious form of spina bifida, is a condition in which the spinal column fails to close around the spinal cord. With myelomeningocele, the spinal cord protrudes through an opening in the spine and may block the flow of spinal fluid and pull the brain into the base of the skull, a condition known as hindbrain herniation. In 2011, the Management of Myelomeningocele study, found that by 12 months of age, children who had fetal surgery required fewer surgical procedures to divert, or shunt, fluid away from the brain. By 30 months, the fetal surgery group was more likely to walk without crutches or other devices.
Now, according to a study published in Pediatrics (24 January 2020), children as young as 6 years old who underwent spina bifida fetal surgery are more likely to walk independently and have fewer follow-up surgeries, compared to those who had traditional corrective surgery after birth. For the study, the authors re-evaluated children from the original trial when they were 6 to 10 years old. Of the 161 children who took part in the follow-up study, 79 had been assigned to prenatal surgery and 82 had been assigned to traditional surgery. Results showed that children in the prenatal surgery group walked independently more often than those in the traditional surgery group (93% vs. 80%); those in the prenatal surgery group also had fewer shunt placements for hydrocephalus, or fluid buildup in the brain (49% vs. 85%); and fewer shunt replacements (47% vs. 70%). The fetal surgery group also scored higher on a measure of motor skills. Fortunately, the two groups did not differ significantly in a test measuring communication ability, daily living skills, and social interaction skills.
According to the authors, while prenatal surgery for myelomeningocele carries benefits and risks, compared to traditional postnatal surgery, the present evaluation of study results provides important information for physicians with patients who are considering prenatal surgery.