Miracle Surgery

Dateline: 11/18/99

It sounds almost too good to be true - correcting potential debilitating defects while a baby is still in the womb. Doctors at the Children's Hospital of Philadelphia have done just that - performed fetal neurosurgery in vivo.

The doctors operated and closed a hole in the tissue that covered the baby's spine. This relieved a condition further up the spinal cord known as hindbrain herniation or chiari malformation that could have caused hydrocephalus. By closing the hole while in the womb, the doctors hoped to circumvent the devastating effects of this condition that occurs in severe forms of spina bifida.

"After making an incision in the mother's abdomen and uterus to expose the back of her fetus, surgeons prepare to correct a spina bifida lesion caused by abnormal development of the spinal cord. The surgery was performed at The Center for Fetal Diagnosis and Treatment at The Children's Hospital of Philadelphia."

After the surgery, magnetic resonance imaging (MRI) scans were taken to determine the effects of the surgery. The MRIs used a technology that did not require the mothers to be sedated.

The results were startling as over time the scans showed that the hindbrain tissue, which had protruded, was now receding. Likewise, pathways for spinal fluid that were blocked by the protruded tissue also opened up.

Of the ten infants, six babies were delivered at term; four were delivered prematurely, while one died shortly after birth. Seven of the ten infants did not need a shunt for hydrocephalus. The remaining two infants required a shunt.

Spina bifida occurs in about 1 out of every 2000 births and is the most common birth defect of the central nervous system (CNS). It is generally caused by a defect early in development that results in an opening in part of the bone that covers the spinal cord. A hindbrain herniation is almost always seen resulting in a part of the brain being squeezed from the skull to the spinal cord. In the most severe form, death can result.

The doctors who performed the surgery are on staff at The Center for Fetal Diagnosis and Treatment of Children's Hospital of Philadelphia. This center is one of only two centers in the world capable of performing comprehensive treatments in fetal surgery.

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For additional information see:

• Neurosurgery In The Womb At The Children's Hospital Of Philadelphia
  ScienceDaily adaptation of the original news release.