King’s College Hospital in London has become the first centre in the UK to carry out fetoscopic (keyhole) surgery on babies with spina bifida while they are still in their mother’s womb.
Guided by ultrasound, a team of neurosurgeons and fetal medicine specialists introduced a camera and instruments through tiny incisions in the mother’s stomach to repair holes in baby’s spinal cord without the need to make invasive cuts to her abdomen.
Until recently, women carrying a baby with spina bifida who decided to continue with their pregnancy could choose to repair the hole in their baby’s back after birth or opt for invasive fetal surgery. This involves making a large incision across the width of the woman’s abdomen during pregnancy to access the uterus, which is then opened to repair the baby’s damaged spine. The uterus and abdomen are then closed and the pregnancy continues.
Using the novel minimally invasive approach, a small incision is made to the woman’s abdomen and a fetoscope – a long, thin tube with a light and camera at the end – is guided into the uterus. The surgeons access the exposed spinal cord which is protruding through a hole in the baby’s back and free it from surrounding tissue so that it can be put back into the spinal canal. A special patch is used to then cover the spinal cord followed by closure of the muscles and skin to prevent spinal fluid from leaking.
Mr Bassel Zebian, Consultant Neurosurgeon at King’s College Hospital, who led the neurosurgical part of the team carrying out the procedure said, “A number of centres around the world have made great strides in open fetal repair over the last few years and demonstrated the benefit of fetal surgery in reducing the severity of the condition and associated complications. The aim of the fetoscopic approach is to reduce the risks to the mother and future pregnancies whilst still ensuring maximal benefit for the baby.”
Dr Marta Santorum-Perez, Consultant in Fetal Medicine, who led the fetal medicine part of the team added, “Only a handful of centres around the world have the required expertise to perform surgery using a fetoscope. We were fortunate enough to train and work closely with Dr Denise Lapa Pedreira, Consultant in Fetal Medicine at the Albert Einstein Hospital in Sao Paolo, who pioneered this technique.”
Sherrie Sharp, 28, from Horsham in West Sussex found out her baby had spina bifida following her 20-week scan at another hospital. Sherrie, who gave birth to a son – Jaxson Nicholas Leonard James Sharp – on Easter Saturday (20/04/19) was one of the first to have the pioneering surgery at King’s. By coincidence, Sherrie herself benefited from the Fetal Medicine Department at King’s – led by world-renowned specialist, Professor Kypros Nicolaides – when she developed severe anaemia while in her mother’s womb and received life-saving blood transfusions through her mother’s abdomen.
Having had first-hand of the expertise at King’s, Sherrie referred herself to the Fetal Medicine Department where she was offered the fetoscopic repair. Sherrie said, “When we found out Jaxson had spina bifida I was given a number of options. We knew we wanted to keep our baby and I’m here today thanks to the specialists King’s so I wanted my baby to have the same chance. The procedure took over three hours and the specialists were happy with how it went. We’re thrilled with our beautiful boy and even though he arrived earlier than expected he’s doing well and his back is healing nicely.”
Spina bifida is a condition whereby a baby’s spine does not close fully during pregnancy leaving a hole in the back and the spinal cord exposed. This causes damage to the spinal cord resulting in weakness or total paralysis as well as loss of sensation in the legs as well as urinary and bowel dysfunction. Many babies with spina bifida also develop problems with their brain including hydrocephalus (a build-up of fluid on the brain), which can further damage the brain and requires drainage.
Surgery during the second trimester of pregnancy has been shown to reduce the degree of weakness in the legs and improve function, as well as reduce the chances of developing hydrocephalus.