Prenatal repair of open spina bifida: history, present, and future

Abstract

Fetal surgery for open spina bifida is the treatment of choice for fetuses with this malformation. However, 14 years after its global implementation, its recognition in Chile remains limited, even among specialists such as obstetrician-gynecologists, neonatologists, and neurosurgeons.

Objective: to synthesize current evidence on fetal surgery for spina bifida, its clinical outcomes, and applicability in the national context.

Methods: Narrative literature review based on a non-systematic search of original articles, reviews, and clinical guidelines in academic databases (PubMed, Web of Science, SciELO), using key terms related to in utero/fetal surgery for spina bifida.

Results: Fetal surgery for spina bifida showed significant benefits over postnatal management by reducing the need for ventriculoperitoneal shunting and improving motor function. In Chile, despite existing experience, implementation barriers persist, including limited access to specialized multidisciplinary teams and adequate funding.

Conclusions: Fetal surgery for spina bifida should be considered the gold standard for eligible fetuses. Health authorities must ensure its availability in both public and private healthcare systems, guaranteeing the fundamental right of access to this therapy, which improves the quality of life of patients, their families, and society.