Although the surgery is highly specialized and more research is needed, the results suggest that ob.gyns. can recommend the procedure to appropriate patients at this time, Dr. Farmer said.
“At the present time, it would be responsible to inform families that this represents an additional option in care that they could consider. The decision to undergo fetal surgery is quite individual and different for every patient, but I think families need to know that this is one option in the armamentarium.”
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Early Results Promising
Although the results are promising, it is important to be cautious in generalizing the success of prenatal surgery for myelomeningoceles to a wider population, Dr. Joe Leigh Simpson and Dr. Michael F. Greene said.
“The study by Adzick and colleagues. is “a major step in the right direction, but the still suboptimal rates of poor neonatal outcome and high maternal risk necessitate the use of less invasive approaches if such procedures are to be widely implemented,” they said.
Results might be less successful for patients treated in centers that are not as experienced in the procedure, Dr. Simpson and Dr. Greene noted.
In addition, more research is needed to determine which fetuses are more likely to benefit from the surgery, and whether performing the procedure earlier in gestation would yield even better outcomes, they added.
DR. SIMPSON is at Florida International University in Miami, and DR. GREENE is at Massachusetts General Hospital in Boston. They made their comments in an accompanying editorial (N. Engl. J. Med. 2011 [doi:10.1056/NEJMe1101228]). Dr. Simpson disclosed that he serves on the advisory boards for Rarecells Diagnostics, Novartis, BioDx, and Bayer HealthCare. Dr. Greene is an associate editor for the New England Journal of Medicine.