WebMD Live Chat Transcript: Invitro Spina Bifida Surgery with Joseph Bruner, M.D.



Fetal Surgery for Spina Bifida

Spina bifida ( a congenital condition in which part of the spinal cord protrudes through a cleft in the spinal column) affects one or two of every 1,000 babies born each year. Once the lesion develops, the constant leakage of spinal fluid can lead to herniation of the brain into the top of the spinal canal, and the formation of hydrocephalus. Depending on where the lesion is on the spine, a baby can have clubbed feet, no bladder or bowel control, and brain damage.

Many babies are aborted after spina bifida is discovered by prenatal testing because the parents or doctors don't yet know that there is a possible treatment for the condition.

Fetal surgery for spina bifida is intended to decrease the handicaps associated with spina bifida by restoring the normal circulation of cerebrospinal fluid in the brain. This procedure can not restore neurological function which has already been lost, but it can reverse some abnormal changes in the brain by stopping the chronic spinal fluid leakage.

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There are risks involved for both mother and baby including blood loss, infection and preterm labor and delivery. These risks will be disclosed in detail during conferences with the patient and many members of the fetal surgery team. A team of ethicists will also meet with the patients to make sure that they understand the risks and benefits of this surgery and are fully able to make a competent decision.

Dr. Noel Tulipan and Dr. Joseph Bruner have been performing open fetal surgery for the repair of Spina Bifida since 1997 and have now done over 60 cases. They are no longer using an experimental protocol in this surgery. It is still too early to predict the final outcome and many of the patients will be followed for years to obtain further information, but results so far are positive and those wishing further information on this procedure for their patients should contact us. A journal article with our first results will be published in the Journal of the American Medical Association (JAMA) and can be see online at: http://jama.ama-assn.org/issues/v282n19/full/joc90448.html.

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