A team from Great Ormond Street Hospital (GOSH) and University College London Hospitals (UCLH) have carried out the first two operations on the damaged spinal cords of babies in the womb, in what are the first surgeries of their kind in the UK.
The team repaired the holes in the babies’ spines in two 90-minute operations this summer. Mums and babies are recovering well.
The operations brought together NHS clinicians from GOSH and UCLH working with researchers from University College London (UCL).
Until now, mums could choose to have the fetal surgery abroad or have postnatal surgery after the baby is born, which is the current practice in the UK.
“In spina bifida, the spinal canal does not close completely, leaving the spinal cord exposed from an early stage in pregnancy. This results in changes to the brain, as well as severe trauma-related injuries to the nerves on the lower half of the body,” said lead neurosurgeon Dominic Thompson of GOSH.
“Closure in the womb is an alternative to postnatal surgery, and improves short and medium-term outcomes. While neither intervention is fully curative, in fetal surgery, the defect is closed earlier which prevents damage to the spinal cord in the last third of pregnancy.”
The GOSH and UCLH team have been learning from Professor Deprest and his team in Belgium. They have also benefited from close links with the Children’s Hospital of Philadelphia where the team led by N Scott Adzick pioneered this operation
“Operating in the womb involves opening the uterus, exposing the spina bifida without delivering the baby, closing the defect and then repairing the uterus to leave the baby safely inside, said lead obstetrician Jan Deprest of UCLH and Belgian hospital UZ Leuven”.
In the surgery the fetus is exposed while the mother is under anesthetic - similar to a Cesarean section. The neurosurgeon then cuts around the exposed spinal cord which is protruding through a hole in the back. After putting the spinal cord back into the spinal canal, a protective tube of muscles and skin is created around it to prevent spinal fluid from leaking. Watch out animation to find out more about the surgery.
A better chance in life
This specialist fetal surgery will give the baby a significantly better chance in life, as babies with spina bifida are very often incapable of walking, and may require a series of operations to drain fluid from the brain (shunt placement) later in life.
“The reduction in need for shunts is particularly important,” said Professor Paolo De Coppi of the UCL Great Ormond Street Institute of Child Health, “as long-term follow-up of children that have undergone prenatal closure in the womb suggests that brain function, mobility, and total independence were higher in non-shunted than shunted children aged 5.”
Professor de Coppi who is also an NIHR Research Professor leads research into the underlying causes of spina bifida and is pioneering advanced treatments for children with birth defects and other structural malformations acquired later in life.
The 30-strong team involved in the first two operations were led by fetal medicine consultant Anna David of UCL and UCLH. Professor David said: “We have been working for three years to bring this service to UK patients through the creation of a Centre for Prenatal Therapy at UCL, UCLH and GOSH.
“Our resolve to offer this service was based on the findings of a large, multicentre, randomised control trial in the US which compared prenatal closure to postnatal closure, and the observation that fetal surgery could be safely reproduced in Europe by proper training.
“The US trial authors found that prenatal surgery was associated with a 50% reduction in the need for surgical shunt placement in the newborn baby and a significant improvement in motor function at 30 months of age.
The research was supported with funding from GOSH Children’s Charity and UCLH Charity, and underpinned by support from the NIHR Biomedical Research Centres at UCLH and GOSH.