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Fetal Surgery Decreases Severity of Brain Defects Among Infants With Spina Bifida

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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 become infected.

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."

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