First steps of a potential new era in fetal intervention for spina bifida

The Lancet Volume 407, Issue 10531 p827-829February 28, 2026  DOI: 10.1016/S0140-6736(26)00029-2 

Repair of open neural tube defects, including myelomeningocele, in the fetus has been shown to improve postnatal outcomes by decreasing the severity of hydrocephalus and, consequently, reducing the need for cerebrospinal fluid diversion. This procedure also improves motor function, increasing the chances of independent ambulation by 30 months.  On the basis of these important benefits, which were shown in 2011 by the Management of Myelomeningocele Study (MOMS) trial investigators, this surgery is now considered part of the standard of care and is offered in many centers worldwide. Nevertheless, even when successful fetal surgery has been done, there remains the risk of substantial and lifelong disability from primary neurological damage (present before surgery). This injury can affect locomotion, neurodevelopment, and gastrointestinal and urological function. 48–58% of prenatally repaired children are still not able to walk independently, 38% need clean intermittent catheterisation due to neuropathic bladder and 40% present with abnormal bowel function by age 30 months.