Pre-Natal Surgery a Possible Treatment
Complications from spina bifida in newborns are being treated through pre-natal surgery with the fetus remaining in the womb. Trials have shown far fewer complications from the birth defect than those who underwent surgery following delivery. Diagnostic techniques have been improved enabling the diagnosis of spina bifida to be made earlier and surgery in utero has shown to offer benefits that outweigh the potential problems.
Most studies of pre-natal surgery involved fetuses diagnosed with myelomeningocele (the most severe form of spina bifida) and with improvements in pre-natal surgery the outcomes have been promising. Newborns who have surgery to cover their spinal cord after delivery have possible complications due to spinal cord damage arising from exposure of amniotic fluid. Any excess fluid in the brain may also require a shunt to drain the fluid which opens the door to infection. Also, the brain stem could be pulled away from the spine during the procedure.
With pre-natal surgery, the surgeon opens the womb and exposes the fetus repairing the spinal cord in utero. This will usually be done between the 19th and 20th week of pregnancy and reduces the potential for nerve damage that has been seen during post-natal surgery. Still with pre-natal surgery, the births are often performed through cesarean to prevent additional damage to the spinal cord.
Those that have undergone pre-natal surgery have a decreased need to use crutches or braces after birth and usually do not need shunts to drain excess fluid from the brain. However, the risk of premature births is higher and there is also danger to the health of the mother but many medical experts believe the benefits of pre-natal surgery to repair the spinal cord outweigh the potential harm.
During recent studies, infants were selected for both pre-natal surgery to repair spinal cord defects along with an equal number having surgery after birth. Two of the infants in each group did not survive the surgery. Of the babies that had undergone pre-natal surgery normally positioned brain stems were experienced and in eight times as many patients when they were 30 months old, twice as many were able to walk without braces or crutches.
It is also believed that pre-natal surgery will prevent the exposure of the spinal cord to additional damage while reducing the leakage of spinal fluid into the brain stem. Fewer neurological complications have also been seen in spina bifida patients who had undergone pre-natal surgery
Dr. Treadwell, Directory at the Fetal Diagnostic Center discusses prenatal diagnosis and treatment
Dr. Farmer, Professor and Chief of Pediatric Surgery discusses the benefits of prenatal surgery