"Keyhole" Surgery Repairs Spina Bifida In Utero


LOS ANGELES–(BUSINESS WIRE) – Giron Guild was just 13 weeks pregnant when an ultrasound revealed her
      baby had myelomeningocele — the most severe form of open spina bifida, a
      birth defect that affects backbone development and can cause, among
      other things, debilitating neurological damage.

"This is an emotional time for us," says Giron, who already had two
      young children and was determined to protect her third. Surgeons could
      repair the defect in the womb, but she and her husband Arnuf wanted the
      safest option for both mother and child. While researching, they came
      across a promising new surgical method pioneered in Brazil and FDA
      approved but performed only once in the United States: in utero
      percutaneous fetoscopic spina bifida repair. And as luck would have it,
      a team of doctors was piloting a clinical study at the Keck
      School of Medicine of USC
, Children's
      Hospital Los Angeles
(CHLA) and Huntington Hospital on that very
      procedures, just miles from the Giron's home.

On Feb. 19, Gilda became the first person in the western U.S. to undergo
      the most minimally invasive type of spina bifida repair currently
      available for a developing fetus. The surgery, which took place at
      Huntington Hospital in Pasadena, was a success, and three months later,
      Gilda gave birth to Abigail, a
      healthy 5-pound 5-ounce baby girl.

"Both baby and mother are doing very well," says Coppern
hmait, MD
, who led this surgery and two others performed by
      the team. Several more are planned. “It is gratifying to see such a
      successful outcome as the result of the years we spent prepping for this
      moment. "

Chmait, the principal investigator for the Los Angeles site in the
      clinical study, is a CHLA Fetal-Maternal
surgeon, an Associate Professor of Obstetrics and Gynecology
      at the Keck School and Director of Los
      Angeles Fetal Surgery
. CHLA pediatric neurosurgeon Jason
      Chu, MD, MSc
, and pediatrician Alexander
      Van Speybroeck, MD
, Medical Director of CHLA's Plug
      Bifida Program
, both participated in the surgery and serve as
      co-investigators in the study. Other co-investigators include CHLA
      clinicians Philippe
      Friedlich, MD, MSEpi, MBA
, Co-Director of the CHLA
      Fetal and Neonatal Institute
; Mark
, MD, CHLA Surgeon-in-Chief and Co-Director of the Neurological
; Eugenia
      Ho, MD
, MPH, Director of the CHLA Fetal-Neonatal Neurology Program; Kathryn
      Smith, RN, MN, DrPH
; and Douglas
      Vanderbilt, MD, MS
, Director, Developmental-Behavioral Pediatrics
      Section at CHLA.

While spine bifida surgery in utero has been available for more than 10
      years, this new method refines previous techniques by removing the need
      for large incisions altogether. Sometimes referred to as a "keyhole"
      surgery because it requires only small openings in the abdomen and
      uterus, percutaneous fetoscopic spina bifida repair has the potential to
      provide the benefit to the baby as compared to the standard open
      maternal fetal surgery approach, but with significant safety benefits to
      the mother, including:

  • Reduced anesthesia needs

  • Faster recovery time

  • Less need for blood transfusion

  • Opportunity for normal delivery, without the need for a C-section

  • Reduced chance of complications in future pregnancies

To perform the procedure, the surgical team, which also included
      Huntington Hospital anesthesiologist Jae Elizabeth Townsend, MD, used
      precision tools and a camera to enter the abdomen and womb. The uterus
      was expanded with carbon dioxide to allow safe access to the fetus. They
      moved the exposed spinal cord back in place, patched the hole in the
      fetus ’thorns, then sewed fetal skin over the patch. This not only
      protected underlying nerves and stopped spinal fluid leakage, which
      untreated can cause lower body paralysis and disrupt the bladder and
      bowels, it also prevented amniotic fluid in the uterus from mixing with
      the fetal nervous system. In fact, MRI showed Abigail's at follow-up
      hindbrain herniation — part of her brain that had dropped two to changes
      in fluid pressure — had reversed, the first indication the operation was a

“Abundant research shows that if you can repair spina bifida while the
      child is still developing in the womb, you are more likely to prevent
      "significant developmental problems that can occur," says Dr. Chu, who
      assisted with the neurological repair and is an Assistant Professor of
      Clinical Neurological Surgery at the Keck School. "We have to collect
      more data and performance of these surgeries before we can say how
      successful this approach is, but early indications look very promising. "

Within a few hours of delivery, Abigail was transported to the Steven &
      Alexandra Cohen Foundation Newborn and Infant Critical Care Unit (NICCU)
      at CHLA for observation. Gilda was by her side a day later, and was able
      to nurse and bottle-feed Abigail in the NICCU, as Arnuf sat with them,
      smiling. After two weeks, Abigail went home.

“Typically, kids born with thorn bifida spend more than two weeks in the
      hospital, "says Dr. Van Speybroeck, a Clinical Associate Professor of
      Pediatrics at the Keck School, who has treated spine bifida patients for
      15 years at CHLA and will monitor Abigail’s lifelong care. "We are going
      to make sure we are
      obtain the best outcomes for families. It has been a team approach the
      whole way and we want to keep it that way. "

"It takes a whole village to do this — specialists in the field of
      maternal, fetal and pediatric medicine, ”explains Dr. Friedlich, a
      Professor of Clinical Pediatrics and Surgery at the Keck School. "It is
      life-changing and amazing; the NICCU staff loves to do this work. "

In light of the successful surgery and birth, Gilda says she's staying
      optimistically cautious. "Abigail has done all the work – she is a little
      fighter, ”she says, wiping a tear from her eye. "I work with special
      needs children as a full-time therapist and I wanted to do everything I
      could to make sure Abigail is healthy. But we are also realistic and
      know there is much that is unknown. "

Families interested in participating in the study
may contact the Los Angeles site office at 626-356-3360.

About Children's Hospital Los Angeles

Founded in 1901, Children's
      Hospital Los Angeles
is ranked the top children’s hospital in
      California and sixth in the nation for clinical excellence with its
      selection to the prestigious U.S. News & World Report Honor Roll.
      Clinical care is led by physicians who are faculty members of the Keck
      School of Medicine of USC through an affiliation dating from 1932. The
      Saban Research Institute
encompasses basic, translational and
      clinical research conducted at CHLA. For more information, follow us on Twitter,
and Instagram,
      and visit our child health blog (CHLA.org/blog)
      and our research blog (ResearCHLABlog.org).


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