Open Fetal Surgery for Myelomeningocele

The Management of Myelomeningocele Study (MOMS) trial, a landmark study in the medical community, was recently completed and the results published in the New England Journal of Medicine.

This prospective, randomized multi-institutional clinical trial was stopped after 183 patients, as there were clear benefits identified in the fetal surgery group. Benefits of fetal surgery compared to standard postnatal treatment included:

• Decreased risk of death or need for cerebrospinal shunt by the age of 12 months
• Improved scores on developmental testing for both mental and motor function at 30 months of age, dependent on the location of the defect

Closure of the myelomeningocele during a woman's pregnancy offers a rare opportunity to improve the outcome for the developing baby. As with any fetal surgery, the potential benefits must be weighed against the possible risks for both mother and baby.

The FDTC is following the inclusion criteria established by the MOMS trial to determine if a patient is a candidate for fetal surgery. A complete fetal evaluation will be conducted, which involves an ultrasound, fetal echocardiogram, and fetal MRI performed at our center. Candidates meeting inclusion criteria will meet with our multi-disciplinary team including maternal-fetal medicine, neurosurgery, anesthesia, neonatology, and social work to discuss the procedure along with its risks and benefits.

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Medical care of this type requires a team of highly-skilled professionals in a variety of specialties. The FDTC at the University of Michigan is pleased to provide comprehensive fetal diagnosis and treatment in an integrated women's and children's hospital setting--Von Voigtlander Women's Hospital and C.S. Mott Children's Hospital. We have specific expertise in prenatal ultrasound, fetal MRI, and fetal echocardiography.

Our team is highly-skilled in all aspects of fetal surgery. For prenatal myelomeningocele repair, we are joined by the accomplished pediatric neurosurgeons at C.S. Mott Children's Hospital led by Dr. Karin Muraszko. She is the Julian T. Hoff Professor of Neurosurgery as well as the departmental chair, and has special interest in congenital anomalies of the spine. Her colleagues include Dr. Hugh Garton, an Associate Professor of Neurosurgery with special interest in the prediction of shunt malfunctions, and Dr. Cormac Maher, Assistant Professor of Neurosurgery with clinical expertise in changes to the developing fetal brain caused by spinal malformations.

After delivery, additional specialists including orthopedics, urology, and pediatric rehabilitation provide care in a collaborative multi-disciplinary Spina Bifida Clinic. This clinic offers ongoing care to children after myelomeningocele repair, and throughout their lifetime.

For an appointment, please contact the Fetal Diagnostic Center at 734-763-4264.