On March 21, a large multidisciplinary team at Yale New Haven Children’s Hospital performed Connecticut’s first in-utero myelomeningocele repair, a complex surgical procedure that can reduce the complications of spina bifida in some children. YNHCH is one of only a handful of U.S. hospitals able to perform the procedure.
Spina bifida occurs when the neural tube of a developing fetus doesn't close completely, leaving the spinal column open. Myelomeningocele is the most serious form of spina bifida, and can result in paralysis, difficulty with bowel and bladder control, excessive fluid in the brain (hydrocephalus) and developmental delay.
Many infants with myelomeningocele have surgery within 48 hours after birth to close the back and protect the spinal cord and other structures. Even with the post-birth surgery, there’s an 80 percent chance the baby will need to have a shunt placed to remove excessive brain fluid.
The in-utero repair involves making an incision in the mother’s abdomen to access the fetus’ spine. Without removing the fetus, pediatric neurosurgeons then close the neural tube, dura (membrane surrounding the spinal cord) and skin.
Studies have shown that performing the repair in utero can reduce the risk of the child needing a shunt to about 20 percent. Depending on the location of the myelomeningocele, the in-utero repair may mitigate other spina bifida complications, said Michael DiLuna, MD, Yale New Haven Hospital chief of Pediatric Neurosurgery.
“This surgery does not cure myelomeningocele, but trials have shown that neurological outcomes are better when the surgery is performed in utero vs. after birth,” said pediatric surgeon David Stitelman, MD, surgical director of the Yale Fetal Care Center. “It can be a dramatic improvement.”
Dr. Stitelman, Dr. DiLuna and maternal-fetal medicine specialist Mert Ozan Bahtiyar, MD, director of the Yale Fetal Care Center, were among nearly two dozen specialists on the team that performed the March 21 procedure. Other team members included adult, pediatric and obstetrical anesthesiologists, pediatric cardiologists, a pediatric ultrasonographer and nurses.
“This was truly a collaborative effort by an extraordinary team. We are very excited about the future of the programs,” Dr. Bahtiyar said.
