The Role of Prenatal Surgery in Myelomeningocele: Outcomes and Future Directions (Atena Editora)

Abstract

INTRODUCTION Myelomeningocele, a severe form of spina bifida, involves the protrusion of the spinal cord and meninges through a vertebral defect due to a failure of neural tube closure during embryogenesis. The incidence varies globally, with folic acid supplementation significantly reducing cases. The condition's etiology includes genetic and environmental factors, and prenatal screening through ultrasonography and fetal MRI is crucial for early detection and management planning. The historical treatment approach of postnatal surgery has evolved with the advent of prenatal surgical techniques, which have shown improved outcomes but come with ethical and technical challenges. OBJETIVE To evaluate the efficacy of intrauterine surgery in reducing neurological deficits and review the advancements in prenatal diagnostic techniques and their impact on management strategies in myelomeningocele patients. METHODS This is a narrative review which included studies in the MEDLINE – PubMed (National Library of Medicine, National Institutes of Health), COCHRANE, EMBASE and Google Scholar databases, using as descriptors: **Congenital Neural Tube Defects** AND **Intrauterine Surgical Techniques** AND **Neurodevelopmental Outcomes** AND **Multidisciplinary Management** AND **Prenatal Diagnostic Advances** in the last years. RESULTS AND DISCUSSION Intrauterine surgery has been demonstrated to significantly improve motor function and reduce hindbrain herniation. Comparative studies between prenatal and postnatal interventions show better neurological and functional outcomes with early intervention. Advances in minimally invasive techniques, particularly fetoscopic surgery, are promising but require further validation. Management of postoperative complications such as hydrocephalus remains critical, with ongoing monitoring and timely intervention essential. Multidisciplinary care, including urological and orthopedic management, along with comprehensive rehabilitation services, is vital for optimizing patient outcomes. Economic analyses favor prenatal surgery due to long-term cost savings from reduced disability. CONCLUSION Managing myelomeningocele effectively requires a holistic approach that integrates advanced prenatal diagnostics, innovative surgical techniques, and robust multidisciplinary support. Continued research and innovation are essential to refine treatment protocols and improve outcomes. Addressing healthcare disparities and ethical considerations ensures equitable access to care, ultimately enhancing the quality of life for individuals with myelomeningocele. The future of myelomeningocele management lies in the seamless integration of these advancements into comprehensive care models.