# Evolving Practices in Prenatal Open Spinal Dysraphism: A Global Survey of Selection Criteria, Surgical Techniques, and Diagnostic Trends

## TL;DR

This study surveys global practices in prenatal spinal surgery, showing how techniques and patient eligibility have evolved beyond earlier guidelines.

## Contribution

The study provides a global snapshot of evolving surgical practices and diagnostic approaches for prenatal spinal dysraphism repair.

## Key findings

- 47.4% of centers offer multiple surgical techniques, including fetoscopic methods.
- Most centers combine ultrasound and MRI for preoperative imaging.
- Genetic evaluation practices vary widely among participating centers.

## Abstract

To provide an updated overview of international clinical practice in prenatal repair of open spinal dysraphism (OSD), focusing on evolving eligibility criteria, surgical techniques, and diagnostic standards.

A structured online survey was distributed to 83 fetal surgery centers worldwide. The questionnaire addressed surgical techniques, maternal and fetal eligibility and diagnostic standards. Descriptive analyses were performed to identify current trends and practice variations.

38 centers from 16 countries participated in the survey (response rate 45.8%). Open fetal surgery remains the most common approach (51.4%) though 47.4% reported offering multiple techniques, including fetoscopic methods. Compared with the MOMS criteria, 42.4% performed surgery beyond 25.6 weeks of gestation, 52.4% accepted a BMI 35%–40% and 28.6% acc epted even a BMI of 41%–45%, and 42.4% treated women with prior uterine surgery. Most centers (87.9%) combined ultrasound and MRI for preoperative imaging. Genetic evaluation was heterogeneous: 66.7% required karyotyping, 63.6% required chromosomal microarray, 18.2% non‐invasive testing, and 6.1% required none. Prognostic indicators such as ventriculomegaly and motor function increasingly influence selection decisions.

International practice in prenatal OSD repair shows broadening maternal eligibility, diversification of surgical approaches, and variable diagnostic strategies. These findings highlight a shift toward individualised care and emphasise the need for further studies to evaluate the impact of practice adaptations.

What is already known about this topic?◦Prenatal repair of open spinal dysraphism can improve neurological outcomes compared with postnatal repair. The MOMS trial established strict eligibility criteria, but real‐world practice has since diversified, with reports of deviations in maternal, fetal, and procedural selection.What does this study add?◦This international survey of 38 centers across 16 countries documents global practice patterns, highlighting procedural diversification, broader maternal eligibility, and evolving genetic testing approaches beyond the original MOMS framework.

What is already known about this topic?

Prenatal repair of open spinal dysraphism can improve neurological outcomes compared with postnatal repair. The MOMS trial established strict eligibility criteria, but real‐world practice has since diversified, with reports of deviations in maternal, fetal, and procedural selection.

What does this study add?

This international survey of 38 centers across 16 countries documents global practice patterns, highlighting procedural diversification, broader maternal eligibility, and evolving genetic testing approaches beyond the original MOMS framework.