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Benefits of Fetal Surgery for Spina Bifida Continue Through School Age


 

The benefits of fetal surgery to repair spina bifida, a procedure pioneered at Vanderbilt University Medical Center (VUMC) in 1997, continue through school age, a National Institutes of Health (NIH) study reports today in the journal Pediatrics.

Children 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 have the traditional corrective surgery after birth, according to the research funded by the National Institute of Child Health and Human Development (NICHD) of the NIH.

The longitudinal study of 161 children who had repairs for spina bifida, the most common birth defect in the central nervous system, was conducted at the three centers that participated in the original Management of Myelomeningocele Study (MOMS) - VUMC, Children's Hospital of Philadelphia and the University of California, San Francisco.

Myelomeningocele, the most serious form of spina bifida, is a complex congenital anomaly resulting from incomplete neural tube closure early in embryonic development. It occurs in about one in 1,500 births in the United States and results in a section of the spinal cord and spinal nerves being exposed through an opening in the back.

Before 1997, the repairs were performed after birth. The 1997 Vanderbilt surgery, performed by Noel Tulipan, MD, and Joseph Bruner, MD, introduced the ability to make the repairs in utero.

In a previous MOMS study, conducted from 2003-2010, the goal was to enroll 200 patients, but the National Institutes of Health ended the trial early after 183 surgeries, based on clear evidence that the prenatal surgery was effective.

The earlier trial found that fetal surgery reduced the need for a shunt by almost 30% and significantly improved the child's chances of being able to walk.

"This is a really unique cohort of patients," said John W. Brock III, MD, Senior Vice President of Pediatric Surgical Services at Monroe Carell Jr. Children's Hospital at Vanderbilt, Professor and Surgeon-in-Chief Emeritus and an author of the study.

"Vanderbilt has been a major player in this very important study. This study confirms that prenatal closure leads to improved mobility and independent functioning and a decreased need for ventricular peritoneal shunting. We have followed these children and mothers for 17 years and this is a continuation of that long-term follow-up. That's the uniqueness of this -- the mere fact that we have been able to do this for so long."

The current study, referred to as MOMS2, evaluated the long-term impacts of prenatal surgery compared with standard postnatal repair in children once they reached school age.

Of the 161 children taking part, 79 had been assigned to prenatal surgery and 82 to traditional surgery. Children in the prenatal surgery group walked independently more often than those in the traditional surgery group (93% vs. 80%). And those in the prenatal surgery group also had fewer shunt placements for hydrocephalus (fluid build-up) in the brain (49% vs. 85%) and fewer surgeries to replace shunts (47% vs. 70%). The prenatal group also scored higher on a measure of motor skills, but 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, MD, of the NICHD Pregnancy and Perinatology Branch, in a press release. "This study provides important information for physicians with patients who are considering prenatal surgery."

Brock said that researchers plan to continue to follow the group of children. The specifics have not been decided.

Other Vanderbilt investigators contributing to MOMS2 are Timothy Cooper, MD, and Sumit Pruthi, MD, associate professor of Radiology and Radiological Sciences.

 
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