Fetoscopic Repair of Spina Bifida
Myelomeningocele, or open neural tube defect (NTD), is the most severe form of spina bifida. It occurs when the spinal cord/neural elements are exposed through the opening in the spine, resulting in partial or complete paralysis of the parts of the body below the spinal opening.
Occurring in more than three of every 10,000 live births in the U.S., it is the most common permanently disabling birth defect for which there is no known cure.
The defect can be repaired in the first few days of life, but many babies develop hydrocephalus and require cerebrospinal shunts for life.
A landmark clinical trial demonstrated that open fetal surgical repair can lead to better outcomes, lower rates of hydrocephalus, decreased need for shunts and improved leg function compared to after-birth repair.
Texas Children’s Fetal Center was one of the first centers to perform open fetal surgery to treat spina bifida in 2011. The procedure has had good outcomes, but it also carries risks, including increased incidence of preterm birth, caesarean section and uterine rupture.
In 2014, a multidisciplinary team at Texas Children’s performed an experimental fetoscopic closure of NTD – the first in the nation. The surgery has the potential to achieve similar outcomes without the dangers of open fetal repair.
The approach was developed over a three-year period by Michael Belfort, MD, PhD, OB/GYN-in-chief, and William Whitehead, MD, pediatric neurosurgeon. It features an in-utero, triple layer, sutured repair through two 4-millimeter incisions in the uterus.
“We believe this is an excellent alternative to open repair, and we are eager to offer it to as many patients as want it,” Dr. Belfort said. “Obviously we have small numbers, and data on outcomes are not long term, but fetoscopic results suggest an equivalent repair to that of open uterus repair, and the obstetric benefits of the fetoscopic approach are immense.”
“Our hope is this innovation and others will lead us to a new era of fetal medicine and surgery,” he said. “With ever-advancing technology and imaging capabilities and dedicated surgeons, I am excited to see the future of repairing anomalies fetoscopically.”