Fetal Surgery Decreases Severity of Brain Defects Among Infants With Spina Bifida
The Vanderbilt babies, on average, showed levels of paralysis equal to what
was expected without surgery, based on the location of the spinal defect, a
finding Noel Tulipan, MD, a pediatric neurologist at Vanderbilt University
Medical Center, termed "disappointing." Tulipan, a co-researcher on one
of the studies, adds, "The benefit [of surgery] is the reduction of shunt
dependence and Chiari malformation [a type of brain defect]."
Whether the babies possess developmental problems is "completely
unknown," Tulipan says. The oldest child, who is 2 1/2 years old, "is
doing well and seems to have normal intelligence," he says. None of the
babies were tested during a return visit to Vanderbilt last spring because they
were considered too young. "There were none that were obviously terrible,
but we are talking about babies who are on average about 6 months old. We are a
long way off before we can present significant data" on their progress.
The Philadelphia group reported on 10 surgeries performed from March 1998 to
February 1999. One fetus was born at 25 weeks and died. Of the nine survivors,
three were delivered earlier than planned -- at 30 or 31 weeks -- while the
remaining six were delivered by cesarean section at 36 or 37 weeks. Four have
some paralysis in both legs or feet, two have problems with one leg only, and
two appear to have no paralysis. Seven have remained without a shunt; two
needed to have a shunt inserted.
"If you can eliminate the need for a shunt, that is a tremendous
thing," Sutton says. "It is a lifelong thing. Some will have 30 to 40
surgeries," because shunts malfunction over time, and the shunt site can
The oldest child who had the surgery in Philadelphia is now 18 months old.
"They all seem to be normal as far as we can tell from the cognitive point
of view," Sutton says.
"I think this is a very important advance in the management of [spina
bifida]," John Freeman, MD, tells WebMD. Freeman, a professor of neurology
at Johns Hopkins University in Baltimore and former head of its genetics birth
defects clinic, reviewed the Vanderbilt study for WebMD. "As with any
advance in surgery, the more they do the better they get. What's important to
me is the procedure can be done, and it can be done relatively safely and that
we hope that that will decrease the motor deficits. We will eagerly look
forward to their next report."