Prenatal Spina Bifida Surgery Improves Functional Outcomes

Fetal surgery to repair myelomeningocele, the most severe form of spina bifida, significantly improves school-age functional outcomes, according to a new study.

Researchers at the Children's Hospital of Philadelphia (CHOP, PA, USA), the University of Pittsburgh (Pitt; PA, USA), the University of California, San Francisco (UCSF, USA), and other institutions conducted a study involving 161 children in order to compare the adaptive behavior and other outcomes at school age (5.9–10.3 years) between children who underwent prenatal corrective surgery (79 children) and those who had conventional surgery after they were born (82 children). Follow-up assessments included neuropsychological and physical evaluations.

The results revealed that children who had surgery before birth had a 93% chance of walking unaided by school age, compared to 80% in the traditional surgery group. The percentage of children in the prenatal and postnatal groups who needed further surgery to place a shunt in the brain to relieve hydrocephalus was 49% and 85%, respectively. Children in the prenatal were almost six times more likely to be able to visit the bathroom on their own compared to the postnatal group, and also showed a far better degree of bladder and bowel control. In addition, quality of life was superior for both the children and their families, and overall stress levels were reduced. The study was published in the January 2020 issue of Pediatrics.

“These findings add to the growing body of literature demonstrating the benefits of prenatal surgery for spina bifida. Providers should take these findings into account when counseling expectant mothers to ensure that families considering prenatal surgery for their fetus understand the potential risks and benefits,” said study co-author N. Scott Adzick, MD, of CHOP. “Fetal surgery is a complex and serious procedure and should only be done by experienced teams. Research needs to continue to refine the technique in a way that will improve outcomes even further.”

Spina bifida is a birth defect that occurs due to failure of the spinal column to form completely around the spinal cord, leaving part of it exposed. The most severe form is meningomyelocele, when the spinal cord and the meninges (the tissue that covers the spinal cord) protrude through the spinal column. If the protrusion is large enough, it can block the flow of the cerebrospinal fluid (CSF). If severe enough, it can draw the lowest part of the brain into the opening at the base of the skull, a condition called hindbrain herniation.

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Children's Hospital of Philadelphia
University of Pittsburgh
University of California, San Francisco