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Fetal Surgery: Landmark Study on Operating in the Womb

Spina bifida and fetal surgery

Surgery for the tiniest patients

Yesterday, a much-anticipated study published in the New England Journal of Medicine reported that doctors were able to successfully perform surgery on fetuses with spina bifida — with remarkable benefits to the children later in life.

With spina bifida, the backbone and spinal canal do not close during fetal development, so the spinal cord and nerves are exposed. Babies born with spina bifida can be paralyzed in the lower half of their bodies, or have their brain stems squeezed into the top of the spinal column. Developmental delays and conditions like hydrocephalus (a build up of fluid in the skull) are common.

Standard treatment has been surgery after birth, but according to The New York Times coverage of the study, since the late 1990’s certain hospitals have been trying to perform surgeries while a baby is still in utero.

Fetal surgery is risky and delicate, so normally it’s used only when the fetus is at risk of dying. Babies with spina bifida do not commonly die, so doctors weren’t sure if going under the knife while still in the womb was worth it.

Turns out, it’s so effective that a safety board stopped the study early so that babies who weren’t scheduled to have the surgery could receive it. Here’s why:

The researchers studied 80 babies who had prenatal surgery (between 19 and 26 weeks) and 80 with postnatal surgery. According to the Times:

“Those who received prenatal surgery were half as likely to have a shunt, and eight times as likely to have a normally positioned brainstem … and at 30 months old, nearly twice as many walked without crutches or orthotics.”

The parents of one boy in the study, Tyson, were told when he was in the womb that his abnormalities were some of the worst they had seen — they predicted he wouldn’t even be able to breath independently.

He had the prenatal surgery and now, at 22 months, he can breath and is starting to talk. And he’s close to walking on his own.

With this study in hand, doctors will want to check it out fetal surgery for use in other conditions, like operating on serious heart defects and bladder blockages, or using fetal bone marrow or stem cell transplants for disorders like sickle cell anemia.

Image: flickr

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