According to a press release from the Mayo Clinic, new research findings show that in-utero neurological surgery for patients with spina bifida is more successful in strengthening brain structure than surgery following birth. The researchers followed three patients with myelomeningocele, a severe form of spina bifida. Read their full findings in Mayo Clinic Proceedings.
About Spina Bifida
Spina bifida is a spinal condition which occurs when the neural tube doesn’t close during the first month of embryonic development. The neural tube is a layer of cells which eventually becomes the brain and spinal cord. So when it comes to spina bifida, the vertebrae aren’t closed around the nerves, which could lead to pain, permanent nerve damage, and paralysis.
There are four types of spina bifida:
- Spina bifida occulta: the most common form with the least severe symptoms. The spinal nerves develop normally, though there may be vertebral issues. The main symptom is back pain.
- Closed neural tube defects: This encompasses deformities of the spinal cord’s fat, bone, or meninges. People with closed neural tube defects often have no symptoms, but may experience partial paralysis or bowel issues.
- Meningocele: The meninges sticks out from an opening in the spine even though the spinal cord is developed. Patients will display a fluid-filled sac covered by skin. Symptoms include complete paralysis and bowl issues.
- Myelomeningocele: Patients with myelomeningocele experience both the spinal cord and meninges sticking out from an opening in the spine in a fluid-filled sac. Patients could experience partial to complete paralysis below the spinal opening, bowel issues, and difficulty walking. Because of the presence of the fluid-filled sac, babies with with myelomeningocele are more prone to dangerous infections and injuries.
Three prenatal patients diagnosed with spina bifida in 2018 underwent surgery between 23 and 26 weeks in the womb to address their spina bifida and corresponding Chiari malformation. The Chiari malformation occurs when the skull is misshapen and presses the brain downwards, making brain tissue enter the spinal column. Symptoms, in children or adults, include headache, neck pain, balance and motor issues, and neurological problems. In some cases, this malformation can cause fluid to build up around the brain. In patients with myelomeningocele, Chiari malformation type II is usually present. Learn more about this condition on our website.
Dr. Rodrigo Ruano, who spearheaded the study, sought to reduce nerve inflammation through surgery to alter fetal spinal defects. He noted that surgery to alter fetal spinal defects could:
“after an in utero intervention, the brain healed itself and prevented a more severe buildup of fluid.”
Six weeks after surgery, brain structure for all three babies had been fully restored.
The Importance of these Findings
With about 1,645 American infants each year estimated to have myelomeningocele, these findings have interesting implications for the future of in utero treatment. Doctors can now learn how to promote brain regeneration and development in the womb. Additionally, gaining deeper insights into the potential applications of in utero surgery can help doctors address other conditions moving forward.