Summer 2011

Infants With Spina Bifida Benefit From Prenatal Surgery

A landmark, multicenter clinical trial led by Diana Farmer, M.D., surgeon in chief at UCSF Benioff Children's Hospital, has found that infants who undergo prenatal surgery to repair spina bifida experience fewer neurological complications than those whose corrective surgery takes place after birth.

In the first randomized, controlled trial to definitively show benefits from fetal surgery, the spina bifida procedure showed significant improvement in the fetal treatment group. For infants with spina bifida, the prenatal surgery:

  • Reduced the need for a ventricular-peritoneal (VP) shunt to divert fluid from the brain
  • Increased the likelihood of being able to walk unassisted
  • Improved motor function

Diana Farmer, M.D.Enrollment in the eight-year study was stopped early so more families could benefit. "This NIH-sponsored study (conducted in conjunction with Children's Hospital of Philadelphia and Vanderbilt University Medical Center) offers real hope for improving the lives of children with spina bifida worldwide," Farmer said.

Easing Disability

The researchers focused on the most common form of spina bifida, myelomeningocele, and the Chiari II malformation that accompanies it. Children with myelomeningocele typically suffer a lifetime of disability that includes hydrocephalus, difficulty in walking and poor bladder and bowel control.

Neural tubeIn the prenatal procedure, the surgeon makes an incision in the mother's uterus, exposing the fetus and the spinal defect. Then, as in the surgery performed after birth, the neurosurgeon repairs the defect. When the children who underwent the prenatal surgery and those who had the postnatal surgery were independently assessed, the study found that:

  • At one year, only 68 percent of the prenatal surgery group versus 98 percent of the postnatal surgery group had hydrocephalus that met the objective criteria for placement of a VP shunt.
  • At 30 months, the children in the prenatal surgery group were twice as likely to walk unassisted (42 percent versus 21 percent).
  • At 30 months, the children in the prenatal surgery group scored higher on standardized tests assessing their mental development and motor function.

Promising, But Not Without Risk

The surgery is now available to selected patients at UCSF, but only after a thorough maternal and fetal risk assessment.

"This is a serious operation, in which a healthy mother undergoes a procedure with the hope of improving the outcome for her unborn child. But it does not come without risk. It can weaken the uterine wall, so all future pregnancies must be delivered via C-section," Farmer said. "That's why, despite the study's very positive outcomes, caution must be exercised. The real plus is that it advances our goal of giving families as many options as possible when there are problems."

For more information, contact the UCSF Fetal Treatment Center at (415) 476-0445 or (800) 793-3887 [(800) RX-FETUS].

Any mother with a suspected diagnosis of spina bifida is welcome to contact the Fetal Treatment center or visit fetus.ucsfmedicalcenter.org.

Summer 2011 Table of Contents

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