Fetal myelomeningocele repair: A narrative review of the historical perspective, emerging regenerative therapies, and future directions.

Abstract

Myelomeningocele (MMC), the most severe form of spina bifida, is currently the only non-lethal condition for which prenatal surgery is performed. This paradigm was established by a randomized trial demonstrating that prenatal intervention reduced shunt rates for hydrocephalus and improved distal neurologic function compared with postnatal repair. There is continued motivation to further improve outcomes for these patients using a variety of regenerative strategies, both explored in the basic science/translational literature and in current practice. In this narrative review, we begin with an overview of the rationale and history of prenatal MMC repair, then describe regenerative strategies including biomaterial-based approaches and early phase clinical trials of stem-cell augemented repairs.