Fetal Surgery for Spina Bifida Shows Benefits

Surgeons have reported a number of short-term benefits following fetal surgery for spina bifida, such as a reduced need for a shunt, the reversal of hindbrain herniation, and better-than-expected neurologic function in the infants' legs. The outcomes were reported in the September 2003 issue of the American Journal of Obstetrics and Gynecology.

The mean gestational age of the fetuses undergoing surgery was 23 weeks, and their mean gestational age at birth was 34 weeks. Of the 50 fetuses undergoing surgery, three died from complications following premature delivery. The remaining 47 all had reversal of the hindbrain herniation, but only 20 (43%) needed a shunt, compared to 85% of shunting for babies who had surgery after birth. Twenty-four of the infants had better neurologic leg function than predicted.

The surgeries were performed by doctors at the Children's Hospital of Philadelphia (PA, USA; www.chop.edu). They hoped that by performing the surgery 20-25 weeks prior to gestation might prevent the progressive neurologic injury that occurs during the later part of pregnancy. However, they noted that this must be balanced against the risk of preterm delivery and the risks to the mother. The doctors did not operate on fetuses in whom fetal ultrasound detected irreversible neurologic damage nor on fetuses in whom the spina bifida occurred at a spinal level that would not be expected to cause neurologic damage.

The authors caution that long-term studies are needed to further evaluate leg function, bladder and bowel function, and neurodevelopment beyond the infant period.




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