Fetal myelomeningocele repair: Rome Fondazione Policlinico A. Gemelli IRCCS experience.
Renata Martinelli, Paolo Frassanito, Luca Massimi et al.
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Case in brief
A fetus with distal lumbar myelomeningocele was assessed by fetal MRI, which showed a 23 × 11-mm defect, ventricular dilatation, and Chiari II malformation. Open fetal repair was performed at 25 weeks of gestation. MRI one month later showed no residual neural tube defect and partial restoration of the cerebellar tonsils and fourth ventricle. The infant was delivered by cesarean section at 35 weeks, with an Apgar score of 9-10 and an uncomplicated neonatal course.
What made this case unusual
The report pairs an illustrative fetal repair with the practical challenges of establishing a low-volume program, including candidate selection, non-directive counseling where pregnancy termination is legally available, and maintaining a specialized multidisciplinary team.
Diagnostic / clinical pearl
Fetal MRI can define the myelomeningocele and associated ventricular and hindbrain findings before repair, and can document anatomical changes afterward.
Why it matters
The authors emphasize that fetal myelomeningocele repair programs require coordinated multidisciplinary care, structured counseling, and long-term neurosurgical follow-up in addition to surgical expertise.