There is no known cure for nerve damage due to spina bifida. To prevent further damage of the nervous tissue and to prevent infection, pediatric neurosurgeons operate to close the opening on the back. During the operation for spina bifida cystica, the spinal cord and its nerve roots are put back inside the spine and covered with meninges. In addition, a shunt may be surgically installed to provide a continuous drain for the cerebrospinal fluid produced in the brain, as happens with hydrocephalus. Shunts most commonly drain into the abdomen. However, if spina bifida is detected during pregnancy, then open fetal surgery can be performed.
Most individuals with myelomeningocele will need periodic evaluations by specialists including orthopedists to check on their bones and muscles, neurosurgeons to evaluate the brain and spinal cord and urologists for the kidneys and bladder. Such care is best begun immediately after birth. Most affected individuals will require braces, crutches, walkers or wheelchairs to maximize their mobility. The higher the level of the spina bifida defect the more severe the paralysis. Thus, those with low levels may need only short leg braces while those with higher levels do best with a wheelchair. Many will need to manage their urinary system with a program of catheterization. Most will also require some sort of bowel management program.
Fetal surgery clinical trials
Management of Myelomeningocele Study (MOMS) is a phase III clinical trial to evaluate the safety and efficacy of fetal surgery to close a myelomeningocele. This involves surgically opening the pregnant mother's abdomen and uterus to operate on the fetus. This route of access to the fetus is called "open fetal surgery". Fetal skin grafts are used to cover the exposed spinal cord, to protect it from further damage caused by prolonged exposure to amniotic fluid. The fetal surgery may decrease some of the damaging effects of the spina bifida, but at some risk to both the fetus and the pregnant woman.
In contrast to the open fetal operative approach tested in the MOMS, a minimally invasive approach has been developed by the German Center for Fetal Surgery & Minimally Invasive Therapy at the University of Bonn, Germany. This minimally invasive approach uses three small tubes (trocars) with an external diameter of only 5 mm that are directly placed via small needle punctures through the maternal abdominal wall into the uterine cavity. Via this route, the unborn can be postured and its spina bifida defect be closed using small instruments. In contrast to open fetal surgery for spina bifida, the fetoscopic approach results in barely any trauma to the mother as surgical opening of her abdomen and uterus is not required.
Further Reading
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