Canezaro Family first to undergo successful two-port fetoscopic spina bifida repair in U.S.
When Althea Canezaro found out she was pregnant, she was thrilled to give her son, Blaine, a sibling. But, her 22-week ultrasound revealed something she didn’t expect – spina bifida.
In 2014,Althea and her son, Grayson, became the first in the United States to successfully undergo a minimally invasive two-port, fetoscopic procedure to repair spina bifida in utero.
After being diagnosed, Althea’s physicians in Baton Rouge immediately referred her to Texas Children’s Fetal Center, where she met with OB/GYN-in-Chief Dr. Michael Belfort, pediatric neurosurgeon Dr. William Whitehead and their team, who explained the delicate surgery and how it could change the course of their son’s life.
“Each doctor took their time answering all of my questions, which put my nerves at ease,” Althea said. “Even though this was the first experimental procedure, I had no fear in me.”
Texas Children’s team of fetal surgeons proposed a new, experimental approach that builds upon the success of the open fetal surgery technique to treat spina bifida, but with a focus on reducing risks to the mother.While open fetal surgery improves motor function in spina bifida patients treated in utero –as proven in a landmark trial known as the Management of Myelomeningocele Study – the procedure requires a six-centimeter opening in the uterus, which increases the risk of uterine rupture and other pregnancy complications.
To counter these risks, Drs. Belfort and Whitehead collaborated with physicians from Vall d’Hebron University Hospital in Barcelona to develop a fetoscopic method using two 4 mm uterine incisions.
“By navigating two small ports with the aid of a fetoscope, our goal is to minimize complications to the mother’s uterus,” Dr. Whitehead said. “The potential risks that occur after open fetal surgery –like preterm delivery, the need for cesarean section for every delivery, and placenta accreta – make the fetoscopic approach more attractive.”
Years of preparation and training went into developing this surgical innovation. It began with Dr. Belfort and Dr. Whitehead practicing the technique in an animal model before creating their own unique inanimate experimental prototype. They performed more than 30 simulated procedures.
After receiving Institutional Review Board approval for this experimental procedure, Texas Children’s multidisciplinary team of fetal experts performed the in-utero spina bifida fetoscopic closure for the first time on July 29, 2014. At 25 weeks gestation, they successfully closed the opening in Grayson’s spine.
Seven weeks later, Grayson was born. Today he is doing remarkably well. “He never developed hydrocephalus and has full movement of his legs,” Althea said. “We are grateful to Dr. Belfort, Dr. Whitehead and their team for helping our son achieve this, which would not have been possible without the exceptional care we received at Texas Children’s Hospital.”
While the fetoscopic procedure is in the early stages of experimentation and refinement, Belfort said, “I’m excited to see what the future holds when it comes to repairing anomalies fetoscopically. With advanced technology and imaging capabilities, our hope is that this innovation will lead us to a new era of fetal medicine and surgery.”
Fetoscopic Repair of MMC
Spina bifida is a type of neural tube defect with a wide range of severity. For the most serious cases of myelomeningocele (MMC), where the baby’s spinal column is exposed and leaking cerebral spinal fluid, Texas Children’s Fetal Center offers a research protocol for fetoscopic MMC repair.The mother receives general anesthesia, a small incision is made using a two-port or three-port fetoscopic procedure, the MMC is repaired by a neurosurgeon, and then the incision is closed.
After a five day recovery at the hospital, the pregnancy is closely monitored with once or twice weekly ultrasounds until birth. While there are risks associated with this invasive procedure, trials have shown potential benefits that are being evaluated, including a smaller uterine scar, the ability to deliver vaginally, and less risk of long-term placenta- related complications while maintaining the same benefit for the fetus.