Thirty years after UCSF doctors performed the world's first fetal surgery, researchers have the first hard evidence that the surgery really works and that the benefits to newborns can outweigh the risks to moms.
In a study published online Wednesday in the New England Journal of Medicine, researchers reported that fetuses with spina bifida, a defect that affects the spinal cord, were less likely to suffer some of the most serious complications of the disease when they were operated on in the womb compared with babies who underwent the same surgery after birth. They were twice as likely to be able to walk unaided by the time they were toddlers......
"This is a huge game-changer for fetal surgery," said Dr. Diana Farmer, lead author of the study and surgeon-in-chief at UCSF's Benioff Children's Hospital. "This study shows it can be done pretty safely, and it will open the door for other patients and other diseases. It really does validate the original hypothesis, 30 years ago, that you could improve the outcomes for these children if you operated on them before birth."
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In the study, 68 percent of the babies who had fetal surgery needed a shunt by the time they were 1 year old, compared with 98 percent of babies who had postnatal surgery. By age 2 1/2, 42 percent of children who had the prenatal surgery were able to walk without orthotics or other devices, compared with 21 percent of the postnatal surgery children.....
During the surgery, which is performed when the fetus is 19 weeks to 26 weeks, doctors make a small incision in the mother's belly, and then cut into the uterus, careful to avoid the placenta.....
A neurosurgeon repairs the spinal cord defect, which involves gently maneuvering the cord into its proper place and closing the hole in the back. The entire procedure takes about two hours.
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