Closing the Gap: Prenatal Repair and the Reimagined Future of Spina Bifida.

Spina bifida, particularly myelomeningocele (MMC), represents a severe congenital anomaly with lifelong consequences. Advances in imaging and screening have improved prenatal detection, enabling early counseling and intervention. Over the past 2 decades, fetal surgical repair has transformed outcomes, as demonstrated by the Management of Myelomeningocele Study (MOMS), with reduced cerebrospinal shunting and improved motor function. However, fetal surgery carries maternal and fetal risks, including preterm delivery and uterine complications. This review examines current evidence on fetal open spina bifida repair, discusses patient selection, long-term outcomes, and emerging innovations, and highlights ongoing ethical and accessibility challenges.