Prenatal detection will undoubtedly become more refined, and may well continue to reduce the incidence of meningomyelocele. Another possible advancement that is often discussed concerns intrauterine surgery (surgery on the fetus while still in the womb) to close a meningomyelocele prior to birth. Experimental work has clearly demonstrated that the exposed neural elements are vulnerable to damage from contact with amniotic fluid. There may in fact be progressive loss of lower extremity function during the latter part of gestation. Since this is the case, it would seem reasonable to close the back as early as possible.
This is certainly attractive from a theoretical point of view. However, in light of the present state of the surgical art, there is, unfortunately, little likelihood that this sort of procedure will be feasible in the foreseeable future.
The incidence of meningomyelocele has declined as a result of prenatal testing. At the present time virtually all children born with this affliction are treated, irrespective of the magnitude of neurological deficit. This is done because there is simply no way to arrange for future care if the back is open and the head growing.
It is essential that there be a continuing interchange between parents and physicians to avoid misunderstandings about the complexity of the problem and the necessity of future treatment. But with the assistance of a multitude of specialists, social workers and psychologists, many of these children will have the potential for enjoying an excellent quality of life.