A Randomized Trial of Prenatal versus Postnatal Repair of Myelomeningocele

In this trial comparing prenatal repair of myelomeningocele with standard postnatal repair, the prenatal-surgery group had better outcomes and better mental and motor function at the age of 30 months. However, these benefits came with some increased risks. Spina bifida is the most common of congenital anomalies of the central nervous system that are compatible with life. The most frequent form is myelomeningocele, characterized by the extrusion of the spinal cord into a sac filled with cerebrospinal fluid, resulting in lifelong disability. Despite folic acid fortification, the incidence of myelomeningocele has stabilized at 3.4 per 10,000 live births in the United States. 1 Liveborn infants with myelomeningocele have a death rate of approximately 10%. 2 – 4 Long-term survivors have major disabilities, including paralysis and bowel and bladder dysfunction. Damage to the spinal cord and peripheral nerves usually is evident at . . .