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Chapter 16.2 - Neural tube defects
from Section 2 - Fetal disease
- By Leslie N. Sutton
Edited by Mark D. Kilby, Anthony Johnson, Baylor College of Medicine, Texas, Dick Oepkes
Book:

Fetal Therapy

Published online:

05 February 2013

Print publication:

13 December 2012, pp 311-319
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Summary

The increasing use of screening ultrasonography and amniocentesis has resulted in early detection of neural tube defects (NTDs), and the use of fetal MRI has improved accuracy of the diagnosis. Spina bifida is considered a potential candidate for in-utero treatment, since the condition is routinely detected before 20 weeks of gestation. Technical difficulties associated with the small size of the fetus and fragility of the tissues generally preclude surgery before 18 weeks' gestation, and after 27 weeks there appears to be no benefit of fetal surgery. Initial screening is carried out with review of data already obtained locally by the treating obstetrician, supplemented by high-resolution ultrasound and MRI performed by the fetal team. The mortality rate for fetal surgery for spina bifida was 6% at Children's Hospital of Philadelphia (CHOP) prior to the trial, but in the Management of Myelomeningocele (MOMS) trial, the mortality was only 3%.