Cleveland Clinic performs its first-ever in utero surgery to repair spina bifida before baby’s birth
An Ohio hospital successfully performed its first in utero fetal surgery to repair a birth defect in a nearly 23-week-old fetus, making it one of few elite medical facilities in the U.S. capable of such a procedure.
A multispecialty team of clinicians led by Darrell Cass, M.D., the director of Fetal Surgery at Cleveland Clinic's Fetal Center, surgically corrected the fetus's spina bifida in February and the baby, a girl, was delivered by C-section near full term on June 3, according to a hospital press release. The baby and mother are both said to be doing well.
"By successfully repairing the defect before birth, we’re allowing this child to have the best possible outcome and significantly improve her quality of life," said Dr. Cass. "There are different measures of quality in determining success for fetal repairs and in this particular case, all metrics for maximum quality were achieved."
Spina bifida is a birth defect that affects the lowest part of the spine and occurs when a fetus's neural tube does not fully close, causing the backbone that protects the spinal cord not to form as it should. It often results in damage to the spinal cord and nerves and can even lead to brain damage.
It is most often discovered during the routine scan typically performed when a fetus is around 18 weeks old, according to the clinic.
Spina bifida can affect a child’s lower leg strength and their ability to walk and run, as well as their ability to go to the bathroom. According to the CDC, approximately 1,645 babies are born with spina bifida each year in the United States.
During the fetal surgery to correct the condition, a C-section-like incision is made to expose a mother's uterus. After an ultrasound is used to locate the placenta and fetus, the uterus is opened 4.5 cm to expose the back of the fetus and the spina bifida lesion. The surgeons then carefully suture several individual layers of tissue in order to cover the defect. After the uterus is closed back up, the fetus will ideally remain in the womb for the remainder of the pregnancy.
Dr. Cass explained to WJW that the surgery is extremely risky for the fetus, as there is potential that the mother delivers the child in the immediate weeks following the surgery. But in this case, the mother carried the child nearly to term before giving birth by C-section, allowing more time for full brain development.
"The operation went perfectly and, in fact, the repair on this baby’s back is the best that I've seen in the last 20 years," he told the station.
Despite the success of the procedure, Dr. Cass cautioned that the child will still have some disabilities and will require further treatment throughout her life.
"Although the surgery was a success, spina bifida is never cured," the surgeon said. "Moving forward, the baby will require ongoing supportive care provided by a multidisciplinary team of caregivers in our Spina Bifida Clinic, which will involve neurology, urology, orthopedics, developmental pediatrics and neurosurgery, among other specialists."