From Sheffield to the Management of Myelomeningocele Study: The Modern Era of Myelomeningocele Management.

Abstract

Myelomeningocele is a neural tube defect associated with high rates of morbidity and mortality. This review traces the evolution of its management, beginning with the Sheffield protocol in the mid-20th century, which promoted early postnatal surgical intervention. Ethical, logistical, and surgical challenges at the time sparked debate among clinicians regarding which patients might truly benefit from surgery. While postnatal intervention did improve survival for some, morbidity and mortality rates remained significant, with many patients facing severe physical and cognitive disabilities. Advances in our understanding of myelomeningocele physiology, surgical techniques, and management of multiorgan complications have shaped modern treatment. Preclinical studies underscored the detrimental impact of open neural tube defects exposed to the amniotic environment, giving rationale to prenatal intervention. Several animal studies and select pilot cases of human patients with prenatal intervention led to the pivotal Management of Myelomeningocele Study (MOMS), which confirmed the advantages of in utero repair over postnatal surgery. While the MOMS trial marked a shift in the standard of care, its implementation remained limited by disparities in access and the strict eligibility criteria of the trial. Ongoing studies have aimed to validate the generalizability of MOMS findings, with hopes of enabling more widespread prenatal intervention.