May 2, 2020

First Fetal Surgery for Spina Bifida Completed at Yale

First Fetal Surgery for Spina Bifida Completed at Yale

In the midst of the ongoing COVID-19 pandemic, Connecticut’s Yale School of Medicine has completed its first fetal surgery for Spina Bifida.

Co-Directors of the Yale Fetal Care Center, David Stitelman, MD (Assistant Professor of Pediatric Surgery) and Mert Ozan Bahtiyar, MD (Associate Professor of Obstetrics, Gynecology, and Reproductive Sciences; Director,), together with Michael DiLuna, MD, FAANS (Associate Professor and Chief, Pediatric Neurosurgery), and a world-renowned team of maternal fetal medicine specialists, including anesthesiologists, cardiologists, and nurses, made history on March 21, 2020, when they performed the first fetal surgery to correct a form of spina bifida, known as myelomeningocele.  This specific form has a limited window for correction in an unborn child’s development.

According to Dr. David Stitelman, “It is a delicate procedure to begin with, and then there’s COVID. If any one of us had gotten sick, we would have had to cancel. It makes you value ‘the team’ even more. In a multidisciplinary case like this, we have to depend on each other.”

Further, Dr. Stileman stated, “It’s not typical to plan for a case like this on Zoom, that’s for sure,” said Dr. Stitelman. Due to the ongoing pandemic, there is an added level of challenge with social-distancing being a priority.  This feat was even more remarkable due to the fact that the consulting, planning, and simulation for the surgery all took place primarily via video-conferencing platforms.

After an ultrasound and fetal MRI confirmed the birth defect, the mother and child were referred to the Yale Fetal Care Center to undergo the procedure on March 21st, which was in the 3rd trimester of the pregnancy (the 25th week). After the preparation and simulations, the in-womb operation was completed in under 90 minutes and both spent around two weeks of bed rest under close monitoring in the hospital.

“Mom is doing really well, and the fetus is kicking like crazy, which is a great sign,” said Dr. Stitelman.

There are approximately 10 cases a year of this type of spina bifida in the state of Connecticut annual, while fewer than 50% of those are candidates for surgery, according to Dr. Stitelman. The success of this current in utero procedure offers a new opportunity for Yale.

Spina bifida is a birth defect to the spine and spinal cord that occurs when the they do not form properly. It’s an example of a neural tube defect.  The neural tube is the structure in an embryo that is developing.  The neural tube eventually becomes the baby’s brain, spinal cord and the tissues that encapsulates them.

Typically the neural tube is formed early on in pregnancy and closes by the 28th day after conception. With babies afflicted by spina bifida, a portion of the neural tube either doesn’t close or doesn’t develop properly, causing defects in the spinal cord and in the bones of the spine.

Spina bifida ranges from mild to severe, which really depends on the type, size, location and complication of the defect. Early treatment for spina bifida involves surgery, when necessary, although such treatment doesn’t always completely resolve the problem.

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