Med Hypotheses. 2011 Jul;77(1):101-5. doi: 10.1016/j.mehy.2011.03.037. Epub 2011 Apr 30.
Surgical intervention in fetal spina bifida developed from the belief that amniotic fluid damages the spinal cord in utero and low spinal pressure from failure of neural tube closure causes hindbrain herniation leading to hydrocephalus after birth for many infants with open spinal lesions. Intrauterine intervention is undergoing a randomised human trial known by the acronym MOMS. It is hoped that randomisation and long-term follow up will demonstrate whether benefits to the infant may result from closure of the vertebral defect before birth. It is argued here that the premise upon which the pathogenesis of neural injury in human spina bifida used to launch this study is mistaken. This has implications for the conduct and conclusions of the trial. It is proposed that fetal surgery improves central nervous system outcome by improving cerebrospinal fluid flow at the foramen magnum. Successful intervention results in a more normal development of both neural and skeletal components of the neuraxis. Closure of the defect is required before signs of hindbrain herniation and ventriculomegaly are evident on ultrasound imaging as these are indicators of the presence of fetal hydrocephalus.
胎儿脊柱裂的手术干预源于这样一种信念，即羊水会损害子宫内的脊髓，神经管闭合失败导致的低脊髓压力会导致后脑疝，从而导致许多开放性脊柱病变的婴儿出生后出现脑积水。宫内干预正在进行一项名为 MOMS 的随机人体试验。人们希望通过随机化和长期随访，可以证明在出生前关闭椎骨缺陷是否会使婴儿受益。这里有人认为，用于启动这项研究的人类脊柱裂神经损伤发病机制的前提是错误的。这对试验的进行和结论都有影响。有人提出，胎儿手术通过改善颅后窝的脑脊液流动来改善中枢神经系统的预后。手术成功会导致神经管的神经和骨骼成分更正常地发育。需要在超声图像上出现后脑疝和脑室扩大的迹象之前关闭缺陷，因为这些是胎儿脑积水存在的指标。
