The University of Alabama at Birmingham Department of Neurosurgery Professor Brandon Rocque, M.D., M.S., was invited to participate in a pediatric debate at the 74th Southern Neurosurgical Society Annual Meeting during “Session V: Sustaining the Argument: Showdowns” on Saturday, March 9, 2024.

The subject of the debate, which was between Rocque and Washington University in St. Louis Department of Neurosurgery Professor Jennifer Strahle, M.D., was postnatal versus prenatal myelomeningocele repair.

Myelomeningocele is a severe type of spina bifida in which the spine and spinal canal do not close fully before birth, resulting in the development of a sac that protrudes from the affected baby’s back area. Reparative surgery can be performed either before or after birth.

Strahle argued the superiority of fetal surgery over traditional postnatal closure of myelomeningocele, citing the results of a Management of Myelomeningocele Study (MOMS) randomized control trial. She also reviewed progress made in technique refinement and outcome improvement since the MOMS trial.

Rocque reasoned that the MOMS trial was limited in that it only included participants who did not have significant negative social determinants of health (SDOH). He reviewed the necessity of accounting for SODH in outcomes across medicine, explaining the significance of this as a limitation of the MOMS trial.

Rocque concurred that the trial showed superior outcomes for fetal surgery but noted that the benefits were small. Finally, he pointed out that the risk of fetal surgery is largely borne by the mother and encouraged the audience to keep this consideration in mind when counseling patients.