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
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.
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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