Citations 2
Prenatal Closure of Myeloschisis vs Myelomeningocele: Insights From the fMMC Consortium Registry
Hersh, David S. , Anuar, Amirul, Anadkat, Jagruti , Bennett, Kelly, Blumenfeld, Yair J. , Buchanan, Christopher Q., Clifford, Caitlin , Emery, Stephen P. , Gebb, Juliana , Goodnight, William H. , Herzeg, Akos , Heuer, Gregory G. , Hirose, Shinjiro , Jampa, Alekhya , Lillegard, Joseph B. , Lim, Foong-Yen, Luks, François I. , Moehrlen, Ueli, Moldenhauer, Julie S. , Cortes, M. Sanz, Schenone, Mauro H., Wagner, Amy J., Zaretsky, Michael V. , Crombleholme, Timothy M., Anadkat, Jagruti , Goodnight, William , Gebb, Juliana S , Moehrlen, Ueli , Cortes, Magdalena Sanz , Schenone, Mauro H , Tsao, KuoJen , Van Mieghem, Tim , Zaretsky, Michael V , Crombleholme, Timothy M , Lim, Foong‐Yen Y. , Miller, Jena L. , Shaaban, Aimen F.
Neurosurgery | February 5, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
BACKGROUND AND OBJECTIVES: Myelomeningocele is defined by the presence of a fluid-filled sac that contains the neural placode and cerebrospinal fluid (CSF) at the level of the spinal defect. Alternatively, the term myeloschisis is used when the neural placode is not contained within a CSF-filled sac. While both are eligible for prenatal closure, few studies have characterized the impact of the type of lesion on postnatal outcomes. This study compares the outcomes of these 2 types of open spinal dysraphism using data from the Fetal Myelomeningocele Consortium registry sponsored by the North American Fetal Therapy Network. METHODS: The prospective observational Fetal Myelomeningocele Consortium registry was used to extract deidentified data corresponding to patients who underwent fetal closure of myelomeningocele vs myeloschisis. Demographics, operative characteristics, perioperative complications, and postnatal outcomes were collected. RESULTS: A total of 1327 patients were identified, including 991 (74.7%) with myelomeningocele and 336 (25.3%) with myeloschisis. Compared with myelomeningocele, myeloschisis was associated with lower rates of prenatal talipes (11% vs 24%, P < .001) and higher rates of favorable prenatal movement (94% vs 86%, P < .001). Postnatally, myeloschisis conferred higher rates of leg movement (97% vs 90%, P = .002) and an increased likelihood of ambulation in the household (10.4% vs 4.1%, P = .009) and outside (7.2% vs 1.9%, P = .004) at 1 year. However, myeloschisis was also linked to greater use of skin patches during closure (49% vs 27%, P < .001), higher CSF leak rates among those with wound dehiscence (26% vs 8%, P = .014), and more frequent CSF diversion and tethered cord surgeries at follow-up. CONCLUSION: Myeloschisis and myelomeningocele demonstrate distinct clinical profiles. Although patients with myeloschisis may have favorable motor outcomes, they are also characterized by higher rates of CSF leakage, CSF diversion, and tethered cord surgery. These findings highlight the need for lesion-specific prognostication and may inform surgical planning and parental counseling in the context of prenatal spina bifida closure.
Fetal Myelomeningocele Closure in the Setting of Maternal Body Mass Index 35 to 40
Hersh, David S. , Anuar, A. Khairul , Bennett, Kelly, Clifford, Caitlin , Emery, Stephen P. , Goodnight, William , Hirose, Shinjiro , Jampa, Alekhya , Lillegard, Joseph B. , Luks, François I. , Moldenhauer, Julie S. , Schenone, Mauro , Zaretsky, Michael V. , Crombleholme, Timothy M., Anuar, Amirul, Elbabaa, Samer K. , Lim, Foong‐Yen Y. , Miller, Jena L. , Moehrlen, Ueli , Schenone, Mauro H , Shaaban, Aimen F. , Tsao, KuoJen
Neurosurgery | October 17, 2025 | Volume: 98 | Issue: 6 | Pages: 1278-1287
BACKGROUND AND OBJECTIVES: The Management of Myelomeningocele Study established a role for maternal-fetal surgery for myelomeningocele (MMC) but was limited to patients with a maternal body mass index (BMI) less than 35 kg/m 2 . However, as the rate of obesity has increased globally, some centers have extended the Management of Myelomeningocele Study criteria to include patients with a BMI of 35 to 40 kg/m 2 . We used the Fetal MMC Consortium registry to analyze the complications associated with maternal-fetal surgery in patients with a maternal BMI < 35 kg/m 2 compared with 35 to 40 kg/m 2 . METHODS: The prospective observational Fetal MMC Consortium registry sponsored by the North American Fetal Therapy Network was used to extract deidentified “maternal complication” and “fetal/neonatal complication” data sets, corresponding to patients with complete entries related to maternal or fetal/neonatal complications, respectively. Demographics, clinical characteristics, and complications were recorded. Propensity score matching was conducted with a 2:1 algorithm, and outcomes were compared between patients with BMI < 35 kg/m 2 and those with BMI 35 to 40 kg/m 2 . RESULTS: Propensity score matching resulted in 156 patients with BMI < 35 kg/m 2 and 78 patients with BMI 35 to 40 kg/m 2 in the “maternal complication” data set, and 130 patients with BMI < 35 kg/m 2 and 65 patients with BMI 35 to 40 kg/m 2 in the “fetal/neonatal complication” data set. No significant differences in the median number of maternal (2.0 vs 2.0; P = .257) or median number of fetal/neonatal (1.0 vs 1.0; P = .409) complications were observed between the 2 cohorts. Furthermore, prematurity rates did not differ significantly between the BMI < 35 and BMI 35 to 40 cohorts. CONCLUSION: Maternal-fetal surgery for open neural tube defect closure is not associated with increased risks among patients with a maternal BMI of 35 to 40 kg/m 2 . Extending the initial inclusion criteria for prenatal MMC closure has the potential to expand access to patients with a higher risk for open neural tube defects.