CIRURGIA FETAL PARA MIELOMENINGOCELE: REVOLUÇÃO TERAPÊUTICA NA MEDICINA MATERNO-FETAL

Abstract

Myelomeningocele is the most severe and functionally disabling form of open spina bifida, combining intrauterine neural exposure, Chiari II malformation, hydrocephalus, motor impairment, neurogenic bladder, and substantial family and health-system burden. Fetal surgery has changed this paradigm by converting a condition historically managed only after birth into a selectively treatable intrauterine disorder, with the potential to reduce progressive neural injury and improve neurological outcomes. This narrative review critically examines the embryological rationale, eligibility criteria, surgical approaches, benefits, maternal-fetal risks, and contemporary gaps in fetal myelomeningocele repair. Clinical trials, cohort studies, systematic reviews, meta-analyses, guidelines, and scientific-society statements published between 2011 and 2026 were prioritized, with emphasis on the MOMS trial and recommendations from ACOG/SMFM, NICE, and the Congress of Neurological Surgeons. Evidence indicates that prenatal repair reduces cerebrospinal fluid diversion, decreases persistent hindbrain herniation, and improves motor function in carefully selected fetuses; however, it is associated with prematurity, preterm premature rupture of membranes, complex uterine scarring, and the need for maternal surveillance in subsequent pregnancies. Fetal surgery for myelomeningocele therefore represents one of the most important revolutions in contemporary maternal-fetal medicine, provided that it is delivered in highly specialized centers with nondirective counseling, longitudinal follow-up, and balanced assessment of fetal benefit and maternal risk.