Best Candidates for Fetal Spina Bifida Surgery May Be Identified Through Brain Scans

UCSF News reports on the discovery by researchers at UCSF Benioff Children’s Hospital San Francisco that fetuses with enlarged ventricles, the fluid-filled cavities inside the brain, may be less likely than other fetuses to benefit from surgery in the womb to treat spina bifida. These findings were based on data from the 2011 Management of Myelomeningocele (MOMS) study, which demonstrated the potential benefit of treating spina bifida, a birth defect, in utero.

The researchers found that fetuses with enlarged ventricles were more likely to require a second surgery to relieve a life-threatening build-up of pressure within the brain. Given the risks that fetal surgery poses for mother and newborn, the findings indicate that in these cases, it may be better to wait until after birth to perform the corrective spinal surgery.  The scientists made this discovery by analyzing data from the 2011 Management of Myelomeningocele (MOMS) study, led by UCSF. In the multicenter MOMS study, the researchers reported that surgically correcting the spinal defect while the fetus is in the womb greatly reduced the need to divert, or shunt, fluid away from the ventricles to relieve hydrocephalus, the life-threatening buildup of pressure inside the skull that sometimes accompanies myelomeningocele.

“Currently, we offer this surgery after extensive counseling and evaluation, and patients have to weigh the risks of open fetal surgery versus the potential benefit that is seen in some babies but not others. This is a grueling decision for parents to have to make because the flipside of doing the surgery is the risk of prematurity,” said co-author Larry Rand, MD, director of perinatal services at the UCSF Fetal Treatment Center at UCSF Benioff Children’s Hospital San Francisco..............

The surgical procedures evaluated in the MOMS trial were developed at the UCSF Fetal Treatment Center under the direction of Michael Harrison, MD, a UCSF professor emeritus considered the “Father of Fetal Surgery.” UCSF researchers performed the pioneering animal studies in the 1990’s that established a rationale for treating spina bifida – the first nonfatal condition treated at the Center – before birth. Already the world leader in diagnosing and treating birth defects in utero, UCSF became the first institution to successfully perform fetal surgery in 1981 and has trained most of the current leaders in the field.