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Getty Images via CNN 
Getty Images via CNN
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(CNN) – In a first in the UK, a team of international surgeons successfully operated the abnormally developed spines of two unborn babies with spina bifida.
Until now, British mothers had to choose between a trip abroad to perform this operation or wait for the birth of their child.
This team of 30 people was completed this summer by two surgeons by researchers from University College London (UCL), clinicians from UCL Hospital, UCL and Great Ormond Street Hospital. (GOSH) and the Leuven University Hospital in Belgium.
The treatment of spina bifida – problem with the development of the spinal cord leaving a cleft or split in the spine – before birth gives babies a better chance in life than surgery after birth, according to the team , as babies born with spina Bifida are often unable to walk and may require a series of other operations later in life, such as setting up a shunt (operation of draining the brain fluid).
"In spina bifida, the spinal canal does not close completely in the uterus, leaving the spinal cord exposed early in pregnancy, resulting in changes in the brain and permanent damage to nerves in the lower half of the body. of the body, "said the chief neurosurgeon, Dr. Dominic Thompson of GOSH.
The closure of the spina bifida while the baby is still in the uterus "substantially improves our income in the short and medium term," added Dr. Jan Deprest, lead fetal neurosurgeon, at UCLH. "Although none of these interventions is curative, the defect is closed earlier in fetal surgery, which avoids spinal cord injury in the last third of pregnancy."
This operation involves making a slightly larger incision than that performed during a caesarean section by opening the uterus. to expose the spine and close the defect, then repair the uterus to leave the baby inside.
Babies are then delivered by caesarean section after about 37 weeks.
The operation was performed more than 40 times in Belgium, where the British team was formed, some patients being English women, since 2012. It was inaugurated at the Children's Hospital of Philadelphia by Dr. N. Scott Adzick's team. The US hospital has performed more than 320 such procedures since 2011.
The treatment was only offered for the first time in Britain, largely because of the "number of procedural, ethical and training problems to be solved" for fetal surgery, Thompson told CNN. The delay reflects the amount of training and infrastructure needed for the operation to proceed safely, according to the surgeon.
Another factor that has slowed down the introduction is the nature of this operation, which concerns two patients, the child and the mother, and could therefore carry risks for the mother.
The British team has been working for three years to bring fetal surgery to Britain. Professor Anna David of UCL hospital said that the decision to carry out the procedure in the United Kingdom was based on a large trial conducted in the United States, which showed that prenatal surgery to correct spina bifida was associated to a 50% reduction in neonatal surgical shunt placement needs and improved motor function at 30 months.
"Reducing shunt requirements is especially important," said Professor Paolo De Coppi of the Institute of Child Health of Great Ormond Street of UCL, "because the long-term follow-up of children with prenatal closure in the uterus suggests that brain function, mobility, and total independence were higher in 5-year-old non-shunted children than shunted ones. "
All affected babies do not benefit from fetal repair, which doctors take into account. Thompson explained that, as with all surgeries, the benefits and risks must be taken into account. Some of the risks involved in this surgery are damage to the uterus or the uterus, premature births and infections.
"Not all [cases] are appropriate, we select those where the benefits are the most important and where the risk can be justified, "he said.Cases such as mothers who have more than one child are not suitable for surgery babies with other birth defects or additional malformations will not be approved for fetal surgery either.
Every day in the United States, about eight babies are born with this disease, according to the American association Spina Bifida.
"The problem with spina bifida is that children are born with a variety of disabilities," Thompson said. But, "by operating before the birth of the child some of the problems of spina bifida, it seems that we can reverse them".
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