The fetal neural tube: is intervention progress?

Fetal therapy has now become a reality and many centres specializing in this field have been established in several countries. The in utero treatment of fetal hydrocephalus is bedevilled by many problems, including poor patient selection, problems with shunt design and general lack of understanding of the pathogenesis of hydrocephalus. Implantation of a ventriculo-amniotic shunt employing a one-way valve into the fetal skull allows continuous evacuation of CSF. One such model has been developed by us and should be ready for clinical trials in the near future. There is strong evidence that the fetal brain has a high capacity for rapid growth and regeneration. However, the process is poorly understood and there is great need for further study. No attempts have yet been made to treat spina bifida in utero. However, the advantages demonstrated in our earlier studies using allogeneic bone transplantation in utero resulted in the development of an allogenic bone paste. This substance can be moulded to any desired shape and is ideal for the restoration of bone loss resulting from cranial injuries or the correction of skull defects. The allogeneic bone paste has been also applied in utero for the repair of surgically induced spina bifida-like lesions in the animal model.