Study: In-utero surgery treats spina bifida

May 9, 2011

Surgery usually takes place within a few days after birth. But now, results from a new study have opened the way for children to get treatment before they are born.

Evan Terrell plays basketball with passion, shooting hoops and making baskets. But he is not just something special on the court. Evan Terrell is nothing short of a medical miracle.

"Most people would never know he had spina bifida. Nothing slows him down," said mother Kristie Terrell.

Doctors first diagnosed Evan in the womb. His tiny spinal cord stuck out of his back. The defect often leads to difficulty walking and brain damage.

"We never, at that point, expected the running or the jumping or the kicking or the sprinting or any of the other wonderful things that he's able to do," the mother said.

But because of surgery done before Evan was even born -- when his mom was just 24 weeks pregnant-- he can do all that and more.

"You make a small incision in the uterus. We don't take the baby out of the uterus. We just position the baby, so we can see what's important to us and fix it," said Noel Tulipan, MD, Professor and Director of Pediatric Neurosurgery ,Vanderbilt University Medical Center.

Results of the seven-year trial show fetal surgery significantly reduces the risk of water on the brain and paralysis.

Dr. Tulipan pioneered the surgery at Vanderbilt University.

"One of the beauties of a fetus is that they heal much better than even a baby, and before a certain age, they can actually heal without a scar," Tulipan said.

Another benefit? Approximately 90 percent of babies born with spina bifida will need a shunt to relieve fluid buildup in the brain. Prenatal surgery cuts that risk in half.

That gives kids like Evan the chance to do what boys do.

"It always makes me nervous to see him jump, but I always let him jump cause I never thought I would see it," said Evan's father, Brian Terrell.

Another score for medicine.

The in-utero surgery still has risks. Women are five-times more likely to deliver a premature baby and are also more likely to develop fluid in the lungs. Surgeons at Vanderbilt are already looking for ways to reduce complications.

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