Main fetal surguries to treat Neural Tube Defects (NTDs): systematic review

Main fetal surguries to treat Neural Tube Defects (NTDs): systematic review
Nafiseh Sami,^1,*
Introduction: Neural tube defects are birth defects of the brain, spine, or spinal cord. They happen in the first month of pregnancy, often before a woman even knows that she is pregnant. The two most common neural tube defects are spina bifida and anencephaly. There is no cure for neural tube defects. However, a variety of treatments can sometimes prevent further damage and help with complications. This systematic review discusses the main advances in fetal surgical therapy aiming to treat NTDs.
Methods: Researches on PubMed and google scholar database and Mehrsys Medical Library have been done and 55 articles were found since 2015. 12 aricles of which were included.
Results: Open fetal surgery reduces the rate of shunting, reverses hindbrain herniation, improves lower extremity function, and improves ambulation. The efficacy of open maternal-fetal surgery for myelomeningocele was proven by the Management of Myelomeningocele Study (MOMS) in 2003, and myelomeningocele is the first nonlethal disorder to be considered for fetal surgical treatment. An infant with myelomeningocele, in which the spinal cord is exposed, can have surgery to close the hole in the back before birth or within the first few days after birth. If an infant with spina bifida has hydrocephalus (excess fluid surrounding the brain), a surgeon can implant a shunt—a small hollow tube to drain fluid—to relieve pressure on the brain. Treating hydrocephalus can prevent problems such as blindness. People with encephaloceles are sometimes treated with surgery. During the surgery, the bulge of tissue is placed back into the skull. Surgery also may help to correct abnormalities in the skull and face. Surgery can separate the spinal cord from surrounding tissue in infants with tethered spinal cord. Finally, there is no treatment for anencephaly or iniencephaly. Infants with these conditions usually die shortly after birth.
Conclusion: Fetal surgery is offered at a few selected facilities with the required special expertise, multidisciplinary teams, and facilities to provide intensive care. It has been shown to improve short-term outcomes for the child, with the consequent risks of prematurity and maternal morbidity. As minimally invasive techniques and equipment evolve, the indications for fetal therapy are likely to expand.
Keywords: Fetal surgery, Neural Tube Defects, spina bifida, myelomeningocele