Researchers are combining mesenchymal stem cells from amniotic and placental sources with bioengineered scaffolds to repair neural tube defects in developing fetuses, moving beyond current surgical approaches that only provide mechanical protection. Preclinical studies in rodent and sheep models demonstrate these stem cells release neuroprotective factors that promote blood vessel formation, reduce inflammation, and actively regenerate damaged neural tissue. The transamniotic stem cell therapy (TRASCET) technique allows treatment without opening the uterus, potentially eliminating the significant maternal risks associated with current open fetal surgery. This regenerative approach represents a fundamental shift from the damage-control strategy established by the landmark MOMS trial in 2011, which showed prenatal surgery could reduce complications but carried substantial risks for mothers. The stem cell strategy addresses both the initial developmental failure and secondary intrauterine damage that characterize severe spina bifida. While promising, this research remains in preclinical phases, and the translation to human applications will require extensive safety testing. The approach could eventually transform treatment for one of the most common birth defects affecting the central nervous system, offering hope for true repair rather than just protection.