Spina Bifida Surgery Before Birth Gives a Lifetime of Benefits

Children as young as 6 years old who underwent fetal surgery to repair a common birth defect of the spine are more likely to walk independently and have fewer follow-up surgeries, compared to those who had traditional corrective surgery after birth, according to researchers funded by the National Institutes of Health.

The procedure corrects myelomeningocele, the most serious form of spina bifida, a condition in which the spinal column fails to close around the spinal cord. With myelomeningocele, the spinal cord protrudes through an opening in the spine and may block the flow of spinal fluid and pull the brain into the base of the skull, a condition known as hindbrain herniation. In 2011, the Management of Myelomeningocele study, funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), found that by 12 months of age, children who had fetal surgery required fewer surgical procedures to divert, or shunt, fluid away from the brain. By 30 months, the fetal surgery group was more likely to walk without crutches or other devices.

For the current study, NICHD-funded researchers re-evaluated children from the original trial when they were 6 to 10 years old. Of the 161 children who took part in the follow-up study, 79 had been assigned to prenatal surgery and 82 had been assigned to traditional surgery. Children in the prenatal surgery group walked independently more often than those in the traditional surgery group (93% vs. 80%). Those in the prenatal surgery group also had fewer shunt placements for hydrocephalus, or fluid buildup in the brain (49% vs. 85%), and fewer shunt replacements (47% vs. 70%). The group also scored higher on a measure of motor skills.

The two groups did not differ significantly in a test measuring communication ability, daily living skills, and social interaction skills.

“Prenatal surgery for myelomeningocele carries benefits and risks, compared to traditional postnatal surgery,” said Menachem Miodovnik, M.D., of the NICHD Pregnancy and Perinatology Branch. “This study provides important information for physicians with patients who are considering prenatal surgery.”

Reference

Houtrow et al. (2020) Prenatal Repair of Myelomeningocele and School-age Functional Outcomes. Pediatrics. DOI: https://doi.org/10.1542/peds.2019-1544

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