Myelomeningocele, the most common form of spina bifida, is in a class of problems referred to as open neural tube defects (ONTD). Spina bifida is one of the most common birth defects. It is an abnormality in which the bone and skin that surround the spinal cord at the back do not form properly. This condition may occur anywhere along the length of the spine, though it is commonly located at the lower back in what are referred to as the lumbar and sacral vertebrae.
Patients with myelomeningocele will have abnormal function of the spinal cord and spinal nerves that come from the involved area of the spine. Patients with myelomeningocele commonly have abnormalities in the function of their bladder, bowels and legs. In addition, patients with myelomeningocele commonly develop hydrocephalus, or excess “water on the brain.” Hydrocephalus is thought to occur due to a blockage in the circulation of fluid that surrounds the brain (cerebrospinal fluid) due to abnormalities in the back of the brain and spinal column, which may occur when there is a lower back defect. It is thought that patients with spina bifida have leakage of the cerebral spinal fluid at the area of defect in the back. This leakage allows the back of the brain to fall, or herniate, down the spinal column leading to compression of this area of brain and blockage of the circulation of fluid. Various studies suggest that there is ongoing damage to the spinal cord and nerves in fetuses with MMC due to the amniotic and uterine environment. For this reason, before-birth repair of MMC was originally proposed.
Recently, it has been shown that fetal surgery improves the outcome for some fetuses with myelomeningocele. A randomized clinical trial, known as the MOMs Trial, proved that fetal surgical repair of MMC leads to decreased rates of hydrocephalus and improved leg function compared to standard after birth repair of this problem. However, the study also showed that there were complications seen in some fetuses that had fetal surgical repair, such as early birth, and rarely, even death. On average, the group treated before birth seemed to do better, but these were selected patients.
The doctors at the Apollo Centre for Fetal Medicine will perform a thorough evaluation of your fetus with MMC. You will meet with pediatric neurosurgeons and pediatricians who specialize in the long-term care of babies with spina bifida. They will review the diagnosis, the range of possible outcomes and treatment options. If your fetus is a candidate for fetal surgery, you will meet with a group of specialists who will review the purposes and risks of the procedure in detail to help you and your family decide what the best treatment approach may be for your individual case.