Advances in Fetal Surgical Repair of Open Spina Bifida. 2023

Ramen H Chmait, and Martha A Monson, and Andrew H Chon
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.

Spina bifida remains a common congenital anomaly of the central nervous system despite national fortification of foods with folic acid, with a prevalence of 2-4 per 10,000 live births. Prenatal screening for the early detection of this condition provides patients with the opportunity to consider various management options during pregnancy. Prenatal repair of open spina bifida, traditionally performed by the open maternal-fetal surgical approach through hysterotomy, has been shown to improve outcomes for the child, including decreased need for cerebrospinal fluid diversion surgery and improved lower neuromotor function. However, the open maternal-fetal surgical approach is associated with relatively increased risk for the patient and the overall pregnancy, as well as future pregnancies. Recent advances in minimally invasive prenatal repair of open spina bifida through fetoscopy have shown similar benefits for the child but relatively improved outcomes for the pregnant patient and future childbearing.

UI MeSH Term Description Entries
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D011295 Prenatal Care Care provided the pregnant woman in order to prevent complications, and decrease the incidence of maternal and prenatal mortality. Antenatal Care,Care, Antenatal,Care, Prenatal
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D005260 Female Females
D005332 Fetoscopy Endoscopic examination, therapy or surgery of the fetus and amniotic cavity through abdominal or uterine entry. Amnioscopic Surgical Procedures,Amnioscopy,Embryoscopic Surgical Procedures,Embryoscopy,Fetoscopic Surgical Procedures,Surgical Procedures, Amnioscopic,Surgical Procedures, Embryoscopic,Surgical Procedures, Fetoscopic,Amnioscopic Surgery,Embryoscopic Surgery,Fetoscopic Surgery,Surgery, Amnioscopic,Surgery, Embryoscopic,Surgery, Fetoscopic,Amnioscopic Surgeries,Amnioscopic Surgical Procedure,Amnioscopies,Embryoscopic Surgeries,Embryoscopic Surgical Procedure,Embryoscopies,Fetoscopic Surgeries,Fetoscopic Surgical Procedure,Fetoscopies,Procedure, Amnioscopic Surgical,Procedure, Embryoscopic Surgical,Procedure, Fetoscopic Surgical,Procedures, Amnioscopic Surgical,Procedures, Embryoscopic Surgical,Procedures, Fetoscopic Surgical,Surgeries, Amnioscopic,Surgeries, Embryoscopic,Surgeries, Fetoscopic,Surgical Procedure, Amnioscopic,Surgical Procedure, Embryoscopic,Surgical Procedure, Fetoscopic
D005333 Fetus The unborn young of a viviparous mammal, in the postembryonic period, after the major structures have been outlined. In humans, the unborn young from the end of the eighth week after CONCEPTION until BIRTH, as distinguished from the earlier EMBRYO, MAMMALIAN. Fetal Structures,Fetal Tissue,Fetuses,Mummified Fetus,Retained Fetus,Fetal Structure,Fetal Tissues,Fetus, Mummified,Fetus, Retained,Structure, Fetal,Structures, Fetal,Tissue, Fetal,Tissues, Fetal
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D016135 Spinal Dysraphism Congenital defects of closure of one or more vertebral arches, which may be associated with malformations of the spinal cord, nerve roots, congenital fibrous bands, lipomas, and congenital cysts. These malformations range from mild (e.g., SPINA BIFIDA OCCULTA) to severe, including rachischisis where there is complete failure of neural tube and spinal cord fusion, resulting in exposure of the spinal cord at the surface. Spinal dysraphism includes all forms of spina bifida. The open form is called SPINA BIFIDA CYSTICA and the closed form is SPINA BIFIDA OCCULTA. (From Joynt, Clinical Neurology, 1992, Ch55, p34) Rachischisis,Spina Bifida,Status Dysraphicus,Cleft Spine,Open Spine,Schistorrhachis,Spinal Dysraphia,Bifida, Spina,Cleft Spines,Dysraphia, Spinal,Dysraphicus, Status,Dysraphism, Spinal,Dysraphisms, Spinal,Open Spines,Rachischises,Spina Bifidas,Spinal Dysraphias,Spinal Dysraphisms,Spine, Cleft,Spine, Open
D016137 Spina Bifida Cystica A form of spinal dysraphism associated with a protruding cyst made up of either meninges (i.e., a MENINGOCELE) or meninges in combination with spinal cord tissue (i.e., a MENINGOMYELOCELE). These lesions are frequently associated with spinal cord dysfunction, HYDROCEPHALUS, and SYRINGOMYELIA. (From Davis et al., Textbook of Neuropathology, 2nd ed, pp224-5) Spina Bifida Aperta,Spina Bifida Manifesta,Spina Bifida, Open,Open Spina Bifida

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