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Friday, February 11, 2011

Exciting Progress

This week there was exciting news published in the New England Journal of Medicine about the potential benefits of intrauterine surgery on a fetus with spina bifida (see also Spina Bifida Association).  In the past, similar approaches have resulted in unacceptable risks to the mother and complications of the pregnancy.  With advances in technology and technique, these risks have been limited and in fact no additional risk to the mothers were found.  Dramatic positive results included (full text at NEJM link above):

  • The first primary outcome, fetal or neonatal death or the need for a cerebrospinal fluid shunt by the age of 12 months, occurred in 68% of infants in the prenatal-surgery group and in 98% in the postnatal-surgery group (relative risk, 0.70; 97.7% confidence interval [CI], 0.58 to 0.84; P<0.001) 
  • The second primary outcome — a score derived from the Bayley Mental Development Index and the difference between the functional and the anatomical level of the lesion at 30 months — was significantly better in the prenatal-surgery group than in the postnatal-surgery group (P=0.007). 
  • In post hoc analyses, infants in the prenatal-surgery group were more likely to have a level of function that was two or more levels better than expected according to the anatomical level (32% vs. 12%, P=0.005) and less likely to have a level of function that was two or more levels worse than the expected level (13% vs. 28%, P=0.03) than were infants in the postnatal-surgery group. 

The New York Times hailed the research as opening the door to the great potential for fetal surgery.  Many days I have happy to be a neurosurgeon, some days I feel GREAT to be a neurosurgeon.  Reading the results of this study, as someone who has spent many hours with these patients and their families, I am thrilled!

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