Since the completion of the Management of Myelomeningocoele Study, maternalfetal surgery for spina bifida has become a valid option for expecting parents.More recently, multiple groups are exploring a minimally invasive approach and recent outcomes have addressed many of the initial concerns with this approach.Based on a previously published framework, we attempt to delineate the developmental stage of the surgical techniques. Furthermore, we discuss the barriers of performing randomized controlled trials comparing two surgical interventions and suggest that data collection through registries is an alternative method to gather high-grade evidence. | INTRODUCTIONAfter its publication in 2011, the Management of Myelomeningocele study (MOMS) has led to a widespread expansion of centers offering prenatal surgery for fetuses with a spina bifida. 1,2 The benefits of prenatal surgery are a reduction in the need for ventriculo-peritoneal (VP) shunt placement, as well as improved mental development, motor and urological outcomes. 1,3 The downside of open maternalfetal surgery is the high maternal morbidity and the risk of uterine rupture due to the large hysterotomy in current and subsequentThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.