Perinatal outcome of our first 20 cases after open fetal myelomeningocele repair at the Zurich Center for Fetal Diagnosis and Therapy

Background: After the MOMS trial was published in 2010, open fetal surgery is considered the standard treatment for selected fetuses with Myelomeningocele (MMC) in experienced hands. We report our data on perinatal outcome of the first 20 in utero operated fetuses.

Patients and methods: The guidelines of the MOMS-Trial protocol were strictly adopted. Operative procedures and all pre- and postoperative management regimens were basically identical with the ones used in Philadelphia. All data were collected prospectively.

Results: Between December 2010 and May 2015, 20 fetal MMC repairs were performed (mean operation time 129 ± 19 min). 19 fetuses (95%) showed reversal of hindbrain herniation within 4 weeks postoperatively. Until today, 18 babies were born via Cesarian section between 32 + 5 and 37 + 3 weeks of gestation (median 36 + 0 weeks). One baby died postnatally due to lung hypoplasia and respiratory failure. As of today, 8/18 babies (44%) needed a ventriculoperitoneal shunt for increasing hydrocephalus. Lower extremity function was better than predicted in 15 babies, two babies showed a lower extremity function according to the anatomic level and one baby showed a lower extremity function one level worse than expected. Maternal safety was preserved in all mothers.

Conclusion: Our findings are well comparable to the data generated by the MOMS-Trial. This demonstrates that, under appropriate circumstances, benchmark results can be obtained outside the former US MOMS-Trial Centers. Furthermore, these European outcome data confirm that select fetuses benefit from in utero MMC repair.