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Fetal Surgery Could Boost Outcomes in Severe Spina Bifida
Date:2/10/2011

By Alan Mozes
HealthDay Reporter

WEDNESDAY, Feb. 9 (HealthDay News) -- Surgery to address the most serious form of the spinal cord birth defect known as spina bifida may be most effective if performed on the fetus, new -- and potentially groundbreaking -- research suggests.

When successful, the surgery could mean the difference between a life spent on crutches or not, experts say, since twice as many spina bifida-affected children ended up walking on their own after the fetal surgery versus those who were operated on after birth.

But the delicate prenatal procedure also comes with hazards, including much higher odds for premature delivery and its attendant problems for newborns.

"While this is a very promising and quite exciting result for this disease, which is otherwise a very neglected disease, not all the patients were helped here, and there are significant risks," study senior author Dr. Diana Farmer, division chief of pediatric surgery at the University of California San Francisco, as well as surgeon-in-chief at UCSF Benioff Children's Hospital, said at a news conference held Wednesday. "So this procedure is not for everyone," she cautioned.

Nevertheless, Farmer added that "it would be responsible to inform families that this [prenatal approach] would represent an additional option in care that they can consider."

Surgery for this "myelomeningocele" form of spina bifida is designed to close up an abnormal opening at the back of the baby's spine. The opening results in spinal cord protrusion, which can alter the movement of spinal fluid and wrench the brain stem down into the skull's base, a development known as "hindbrain herniation."

Surgery to correct the condition has traditionally been performed after birth.

However, the new report, published online Feb. 9 in the New England Journal of Medicine, suggests that delicate surgery performed in utero actually reduces the su
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