May 8, 2013
Risks and Rewards of Prenatal Surgery for Spina Bifida
New advances in surgery are allowing prenatal repair (in utero). Are the results worth the risks involved for both the mother and unborn child? For me, I believe the answer would be yes. I would be willing to risk anything to give my child a chance at a normal, healthy life. I believe all children deserve that chance. A friend of mine has a daughter that is 22 weeks pregnant. She recently found out that her unborn son has spina bifida. She was told about a study at Vanderbilt for prenatal repair of spina bifida. Without this surgery her son would be born paralyzed. She has decided that the benefits are worth the risk and has been accepted into the study. She will have to live in Nashville for the remainder of her pregnancy to be near the doctors and hospital in case of any complications. I never knew surgeries like this were possible and am amazed and excited about this new technology. Hopefully one day all birth defects will be curable. Spina bifida, which literally means “cleft spine,” is characterized by the incomplete development of the brain, spinal cord, and/or meninges (the protective covering around the brain and spinal cord). It is the most common neural tube defect in the United States—affecting 1,500 to 2,000 of the more than 4 million babies born in the country each year. There are an estimated 166,000 individuals with spina bifida living in the United States. ("National institute of," 2012) There are four types of spina bifida: occulta, closed neural tube defects, meningocele, and myelomeningocele. Occulta is the mildest and most common form in which one or more vertebrae are malformed. The name “occulta,” which means “hidden,” indicates that the malformation, or opening in the spine, is covered by a layer of skin. This form of spina bifida, present in 10 to 20 percent of the general population, rarely causes disability or symptoms. Closed neural tube defects make up the second type of spina bifida. This form consists of a diverse group of spinal defects in which the spinal cord is marked by a malformation of fat, bone, or membranes. In some individuals there are few or no symptoms; in others the malformation causes partial paralysis with urinary and bowel dysfunction. In the third type, meningocele, spinal fluid and the meninges protrude through an abnormal vertebral opening; the malformation contains no neural elements and may or may not be covered by a layer of skin. Some individuals with meningocele may have few or no symptoms while others may experience symptoms similar to closed neural tube defects. Myelomeningocele, the fourth form, is the most severe and occurs when the spinal cord/neural elements are exposed through the opening in the spine, resulting in partial or complete motor paralysis and sensory deficits within the parts of the body below the spinal opening. The paralysis may be so severe that the affected individual is unable to walk and may have urinary and bowel dysfunction. ("National institute of," 2012) A landmark study, co-led by experts at Vanderbilt University Medical Center, proves that babies who have surgery to repair spina bifida while still in the womb have better outcomes than babies who have surgery after birth. The positive outcomes include a decreased risk of death or need for shunt placement in the brain by the age of 12 months, plus improved mental and motor function. (Carrel Jr., 2012) Members of the fetal surgery team at Vanderbilt pioneered the innovative surgical procedure to repair myelomeningocele, the most serious form of spina bifida. Surgeons at Vanderbilt performed the first-ever in utero repair for myelomeningocele in 1997 on Corey Meyer and her unborn son Daniel. Since those early procedures, Noel Tulipan, M.D., internationally renowned neurosurgeon and director of pediatric neurosurgery, has performed more than 200 prenatal surgeries to repair the spina bifida defect....
References: "The Children 's Hospital of Philadelphia." Center for Fetal Diagnosis and Treatment. N.p., n.d. Web. 8 May 2013. .
Center for fetal diagnosis and treatment. (2012, September). Retrieved from http://www.chop.edu/service/fetal-diagnosis-and-treatment/fetal-diagnoses/spina-bifida.html
Carrel Jr., M. (2012, November 13). Fetal surgery for repair of spina bifida. Retrieved from http://www.childrenshospital.vanderbilt.org/interior.php?mid=8205
National institute of neurological disorders and stroke. (2012, October 25). Retrieved from http://www.ninds.nih.gov/disorders/spina_bifida/detail_spina_bifida.htm
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