In a condition known as spina bifida, children are born with an exposed spinal cord, which causes numerous physical and developmental issues. Usually, surgeons will operate on spina bifida after birth, but a complex in utero surgery can allow the baby to develop better while still inside the mother's womb.
In a United Kingdom first, a team of specialists from University
College London (UCL), University College London Hospitals (UCLH), and Great
Ormond Street Hospital (GOSH) performed surgeries on two different babies with
spina bifida while they were still in their mothers' wombs.
The specialists conducted the two surgeries over the summer and
now report that both mothers and both babies are doing well.
This was the first time that surgeons have conducted the
procedure in Britain, where only postnatal operations had been possible up to
this point.
Over the summer, however, the British surgeons teamed up with
specialists from the University Hospitals Leuven in Belgium to make the
intervention more widely available.
The U.K. experts explain that babies who receive the corrective
intervention in utero are more likely to develop better than those who receive
postnatal procedure.
"In spina bifida, the spinal canal does not close
completely in the womb, leaving the spinal cord exposed from an early stage in
pregnancy," explains lead neurosurgeon Dominic Thompson, from GOSH.
"This results in changes to the brain, as well as severe
permanent damage to the nerves on the lower half of the body," he adds,
which means that the child may often need additional surgical interventions
later in life.
However, tackling the problem as early as possible — ideally
while the baby is still in the mother's womb — may allow it to avoid some of
these developmental problems.
A complex surgical procedure
The prenatal surgery is complex and difficult to perform, but
the British surgeons were keen to make it accessible to a larger number of
people.
"Operating in the womb involves opening the uterus,
exposing the spina bifida without delivering the baby, closing the defect, and
then repairing the uterus to leave the baby safely inside," says lead
fetal surgeon Jan Deprest, who works with both UCLH and University Hospital
Leuven.
"Closure of spina
bifida in the womb using this method is an alternative to postnatal surgery,
and has been shown to improve short and medium-term outcomes. While neither
intervention is fully curative, in fetal surgery, the defect is closed earlier,
which prevents damage to the spinal cord in the last third of pregnancy."
The surgeon also notes that he and his colleagues are hard at
work to see whether a specialized endoscopic procedure called fetoscopy would
be useful in correcting spina bifida.
This type of intervention is minimally invasive and would allow
the doctors to operate on the fetus without opening the mother's uterus.
"We are [...] researching the minimal access (fetoscopic)
technique through the GIFT-Surg Project framework and, if we can show it to
have equal benefit, we will be offering this option to patients," Deprest
says.
Source: Medical News Today
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