Myelomeningocele treatment options
While an MMC diagnosis may be life-changing, myelomeningocele treatment can help your child thrive – both during pregnancy and after birth.
At the Colorado Fetal Care Center, your treatment options are more than just that – they're carefully designed strategies to give your baby the best quality of life. We have a specialized team dedicated to treating babies with myelomeningocele. As one of the nation's top fetal care centers, we offer some of the most innovative MMC treatments available.
Before deciding which myelomeningocele surgery is best for your family, our fetal care team works closely with you and other specialists. We evaluate your baby's condition and the severity of their MMC using fetal diagnostic tests like fetal ultrasound, fetal MRI and fetal echocardiography. Only then do we design and offer a treatment plan.
Prenatal myelomeningocele repair
For some families, our fetal experts recommend treating MMC before the baby is born by performing a myelomeningocele repair in utero. We recommend myelomeningocele repair before birth if it can:
- Give the baby their best chance at thriving
- Improve the likelihood of walking
- Prevent other injuries or complications
- Prevent further neural damage and more cerebrospinal fluid from leaking
- Decrease the chances the baby will need a shunt in the future to drain fluid from their brain
When a baby has a condition like MMC, their nerves could be damaged by amniotic fluid, cerebrospinal fluid and direct trauma.
We offer two options for myelomeningocele surgery before birth: open fetal surgery and fetoscopic repair. Requirements for being eligible for either surgery include:
- Healthy amniocentesis reading
- Healthy fetal echocardiogram
- Surgery is often done between 23 and 26 weeks gestation
Open fetal surgery for myelomeningocele
Open fetal surgery allows our expert fetal surgeons to perform surgery on your baby during pregnancy and place them back in the womb so they can continue developing and increase their chances for a great outcome.
What to expect from open fetal surgery for MMC spina bifida repair
Before the procedure begins, your obstetric and fetal anesthesiologist will give you anesthesia to put you to sleep and relax the uterus. The anesthesia passes through the placenta to your baby, allowing the surgical team to open the uterus, perform the in-utero MMC repair and close the uterus – all with minimal interference to your pregnancy.
During the MMC surgery, fetal surgeons will make an incision in the abdomen to open the uterus and access the defect in your baby's spine. Then a highly specialized pediatric neurosurgeon will repair the myelomeningocele, close the skin of your baby's back over the opening to protect their still-developing neural tissue. The incision on your wound is then closed.
Once the procedure is done, we leave the baby to keep growing and developing, all while monitoring closely with frequent ultrasounds. We’ll then deliver your baby via cesarean section (C-section) around 37 weeks gestation.
What are the risks of open fetal surgery?
Risks to the mother from open fetal surgery may include obstetrical complications and potential scarring that could affect future pregnancies.
There is some risk to the baby during in-utero surgery, but the team at our Colorado Fetal Care Center has successfully performed more prenatal MMC spina bifida repairs than most fetal centers in the country. In our dedicated fetal surgery suite, our team of specialists is ready and capable of handling anything that may occur during the treatment or birth process.
Fetoscopic myelomeningocele repair
Fetoscopic MMC repair is a minimally invasive procedure in which our fetal surgeons insert a small camera called a fetoscope and small surgical instruments into your uterus to repair your baby’s MMC. This surgery can provide you with more options for your delivery and for delivery for future pregnancies – fetoscopic repair allows the mother to still have a vaginal delivery whereas open surgery would then require a C-section.
What to expect from fetoscopic myelomeningocele repair?
Before the procedure begins, your obstetric and fetal anesthesiologist will give you epidural anesthesia as well as general anesthesia through an IV. This puts you and your baby to sleep and relaxes the uterus.
We’ll make a similar incision as with open surgery to bring the uterus out, but instead of opening the uterus to perform the procedure, we’ll insert the small surgical tools inside the uterus through three ports and perform the surgery that way.
After we’ve repaired the myelomeningocele, we’ll close the skin of your baby's back over the opening to protect their still-developing neural tissue and close the incision in the womb. We’ll then close the small incisions in the uterus and abdomen.
We monitor your progress in the hospital for the next 4 to 5 days, then schedule an MRI for about two weeks later. Local patients can go home after they are discharged but we prefer those who have traveled to see us stay nearby for two weeks until we do the follow-up MRI.
What are the risks for fetoscopic myelomeningocele repair?
Similar to open surgery, the main risk we face for fetoscopic repair is a premature delivery. The anticipated delivery time is about 32 to 34 weeks gestation but many pregnancies go beyond that period. It’s important to note that this is a newer procedure we are still learning about long-term outcomes.
Post-birth myelomeningocele treatment
If your fetal care team decides it’s best to repair your baby’s MMC after they're born, the treatment includes:
- Frequent ultrasounds during pregnancy to monitor your baby’s growth
- Delivering your baby via C-section at full term
- An evaluation by your baby's care team and neurosurgeon after delivery
- Surgery to close the MMC within the first two days of life
Your child's care team will also evaluate your child for signs of increased pressure in their brain (a condition known as hydrocephalus). If present, we’ll likely insert a ventriculoperitoneal shunt, which is a tube that helps drain excess spinal fluid from the brain into the abdominal cavity.
We’ll continue follow-up care at our Spina Bifida and Spinal Cord Injuries Clinic. There they'll receive follow-up care and monitoring by a multidisciplinary team of neurologic, orthopedic, pediatric and urologic specialists as well as occupational and physical therapists.
Why choose our Colorado Fetal Care Center to treat your baby's myelomeningocele?
Our fetal care team has the experience and expertise to meet all your family’s needs. From pregnancy management and diagnosis to treatment and long-term care, we have the experience, team and facilities to provide the highest quality care and achieve the best possible outcome.
Our average delivery age for babies who've undergone in-utero MMC repair is 32 to 34 weeks, meaning we give your baby as much time as possible to grow.
When you come to our Colorado Fetal Care Center for your baby's myelomeningocele care, you benefit from a dedicated team of experts who have spent years researching, innovating and performing this treatment.
Even though it’s a rare disease, the size and level of our program allows us to see more babies with MMC than most programs around the world. The more we see, the better we become at treating the condition. We also track our data and outcomes so you can see how we’re improving. For instance, shunts to help fluid drain from the brain after surgery used to be somewhat common. However, in recent years, we rarely need to place shunts, which reduces the risk for complications.
Not only does tracking and reporting our outcomes help tell you that you’re coming to the right place, it also helps us improve our processes.
Comprehensive, consistent care
We make it easier on parents, their baby and the whole family by surrounding you with the same faces every day. You'll meet with every provider on your care team on day-one. And this same team will be with you every step of the way, so they know all the details of your care. And we know your baby's needs don't end at delivery, which is why we make the transition to our Neonatal Intensive Care Unit (NICU), specialty care and home as seamless as possible.
No question goes unanswered
All our specialists and providers are under the same roof at Children's Hospital Colorado. This means that your questions are answered faster, you have instant access to our expertise and we're ready to handle anything that may arise. We’ll explain all your care options based on your baby’s condition and create a care plan with you based on your goals.
We keep families together
We know how nervous and excited you are to meet your new baby, which is why we do everything we can to get your baby safely into your arms. Children's Colorado is one of the few children's hospitals in the nation with a labor and delivery unit and if recommended, you can deliver onsite just a few steps away from our Level IV NICU. If preferred, we can also coordinate with your local provider so you can deliver your baby closer to home.
Our Labor and Delivery Unit and Level IV (four) NICU are right down the hall from each other, so you can easily visit your newborn as much as possible – and this is all under the same roof as nationally-ranked pediatric care.
If you’re interested in learning more about our fetal care specialists or would like a second opinion, please contact our Colorado Fetal Care Center at 720-777-4463.