Fetal Surgery for Spina Bifida
Fetal surgery, the use of invasive techniques to treat birth defects whilst still in-utero, was first pioneered in the 1980s. Improvement in antenatal diagnostics and development of surgical interventions have led to an increased interest and practice in this field over the last twenty years. Surgery on the placenta, cord or membranes using a fetoscopic technique was further developed in the 1990s, as equipment and technology improved to allow access to the uterine cavity through small ports. Studies confirmed the advantage of fetoscopic laser surgery for the treatment of twin-to-twin transfusion syndrome, and this is now widely offered in fetal medicine units throughout the world.
Surgery performed directly on the unborn baby has been attempted for a variety of conditions that are usually lethal or may be associated with less morbidity when corrected early. Examples of these are congenital diaphragmatic hernia (CDH), open spina bifida (myelomeningocele, MMC), lower urinary tract obstruction, thoracic space-occupying lesions, sacrococcygeal teratoma and cardiac malformations. For many conditions, these techniques are still experimental; there is currently a clinical trial in progress evaluating fetoscopic tracheal occlusion for CDH.
In 2011, the MOMS trial (1) showed that open fetal surgical repair of MMC was relatively safe for mother and baby and that fetal repair versus traditional neonatal repair was associated with improved neonatal motor outcomes and reduced need for ventriculo-peritoneal shunting. In-utero repair of MMC has since become a relatively common form of fetal surgery performed worldwide, with many centers now offering open fetal surgery or fetoscopic techniques. In this rapidly evolving field, it is of great public interest to ascertain what prenatal treatments for open spina bifida are currently being offered and planned around the globe. This has proved challenging, due to the lack of global coordination in fetal surgery, national variations in care models, geographical distance, and language barriers. Through the International Society for Prenatal Diagnosis, our Fetal Therapy SIG aims to provide a central resource for health professionals and patients containing current information about the global availability of fetal surgery for MMC. This project was initiated with a 2017 questionnaire to a selection of fetal medicine and pediatric neurosurgery experts around the world who were known or thought to be providing this service. The responses to this survey are shown in the below interactive map. We invite all units not included in this map to submit their details to the ISPD Fetal Therapy SIG for inclusion in this public resource.
This project is ongoing, and any feedback, additions and updates to this webpage can be made by contacting eirtenkauf@ISPDhome.org.
Adalina Sacco1, Anna David1, Lynn Simpson2
1 Institute for Women’s Health, University College London
2 Department of Obstetrics & Gynecology, Columbia University Medical Center
1. Adzick et al N Engl J Med 2011; 364:993-1004
Disclaimer. Please note that ISPD does not endorse any specific group included on this map. The accuracy of the information provided is the responsibility of the contributing center and has not been independently verified by ISPD. Note that the location marker may not be exact in order for each center to display on the map view.
Current provision of fetal surgery for spina bifida is shown in the below interactive map. Note that some locations may not be exact in order to view separate centers on the map.
= Location reported that service is not yet established.