More than 24 babies from around the country who were diagnosed with myelomeningocele (the most severe form of spina bifida) have a better chance of walking because of a groundbreaking surgery performed at the St. Louis Fetal Care Institute before they were born.
Spina bifida, which impacts 1 in every 1,000 babies born, is caused when the back's bones do not come together during development to protect the spinal cord. “This results in exposed nerves and damage to the spinal cord as the pregnancy continues. It can cause paralysis, kidney problems, and lack of bowel or bladder control,” says Dr. Mike Vlastos, director of the St. Louis Fetal Care Institute.
The in-utero surgery performed at the St. Louis Fetal Care Institute at Cardinal Glennon closes this gap, reducing, or even eliminating, major complications including the lack of movement in the lower extremities. In addition to protecting the spinal cord, the surgery can also help reverse an Arnold Chiari II malformation. “When this happens the brain is positioned further down into the upper spinal column than normal. The normal flow of fluid out of the brain is obstructed, causing hydrocephalus, an excess of cerebrospinal fluid within the brain.
After they are born, most children with hydrocephalus need to have the extra fluid shunted out of the brain into the abdomen via a ventriculoperitoneal (VP) shunt. Fetal surgery has been shown to reduce the need for this shunt,” Vlastos says.
The fetal myelomeningocele repair surgery, performed between 19 and 26 weeks into a pregnancy, involves making a small opening in the uterus, then closing the spinal cord opening; the womb is repaired and the mother is in the hospital for four to five days.
In May 2011 The St. Louis Fetal Care Institute was one of the first centers to offer the surgery following the release of the MOMS (Management of Myelomeningocele) trial results. In this National Institute of Health (NIH) sponsored trial, patients facing a spina bifida diagnosis were randomly assigned to undergo fetal surgery or receive standard postnatal surgery. It was found that babies who have the fetal surgery often have better outcomes than those who receive the standard repair surgery after birth.
Since then, more than 24 unborn babies have received the surgery at The St. Louis Fetal Care Institute, making it one of the fastest growing programs in the country. “We have seen positive outcomes, and are optimistic about the future for these little ones,” says Vlastos. “We look forward to helping even more families facing the same diagnosis.”