Fetal Surgery Decreases Severity of Brain Defects Among Infants With Spina Bifida
Nov. 11, 1999 (Washington) -- Before the advent of fetal surgery, the only
two options for women whose fetuses were found to have spina bifida were to end
the pregnancy or subject the infant to surgery almost immediately after birth.
But fetal surgery, surgery performed while a fetus is still developing in the
womb, may provide another option.
Spina bifida is a serious disorder caused when fusion of the developing
spinal cord does not occur properly. Children with spina bifida have various
physical disabilities and experience many developmental delays. Some suffer
from brain defects. Many have an obstruction along the abnormal spinal cord
that causes fluid to collect in the brain. This condition, called
hydrocephalus, requires a shunt to be inserted in their spine to help drain
this fluid out of the brain. This surgery must be performed immediately after
birth and repeated throughout their lives to maintain it.
Now physicians at Vanderbilt University in Nashville and Children's Hospital
in Philadelphia report that they have successfully repaired spina bifida
lesions in several dozen affected fetuses. Using fetal surgery, they have
significantly reduced the severity of the brain defect that accompanies the
disorder and decreased the need for shunts after birth. The Vanderbilt and
Philadelphia physicians have been at the forefront of pioneering fetal surgery
for spina bifida and are the only medical groups performing the surgery
However, their surgical feats, described in the Nov. 17 issue of
JAMA, also come with serious complications to the mother. And the
surgeons still don't know much about how the infants -- about half of whom are
born prematurely -- are faring developmentally.
"I can say this is a success in that we are reversing [brain]
malformation," lead researcher Leslie Sutton, MD, a neurologist at
Children's Hospital, tells WebMD. "Our preliminary data indicates we are
putting in less shunts, and as far as the legs, we have 4-5 [infants] that had
better leg motion than what was expected. We are very encouraged about
The Vanderbilt study compared 29 infants with spina bifida who had fetal
surgery and 23 with the disorder who did not have fetal surgery. Overall, about
60% of those undergoing the surgery required a shunt to treat hydrocephalus,
while almost 90% of those without fetal surgery required a shunt. Only 7% of
the fetal surgery group had moderate or severe brain defects compared with 45%
of the nonsurgery group.
But the researchers were troubled by some of their findings. Those
undergoing fetal surgery were born premature, on average, at 33 weeks. Those
without the fetal surgery were born at term, on average at 37 weeks. Fifty
percent of the women who underwent surgery had to be hospitalized for preterm
labor, compared with 9% who did not have surgery.