Fetal surgery for myelomeningocele: trials and tribulations. Isabella Forshall Lecture.

The rationale for in utero repair of myelomeningocele (MMC) in the context of pathologic observations, animal models, and outcomes from the initial experience with human fetal MMC repair is presented. This has now culminated in a randomized trial, Management of Myelomeningocele Study, the findings of which are listed. The story is focused on the milestone contributions of members of the Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia on the road to successful fetal surgery for spina bifida. This is now performed in selected patients and presents an additional therapeutic alternative for expectant mothers carrying a fetus with MMC.