Fetal Surgery & Therapy / Spina Bifida In-Utero Repair
Fetal Surgery Program
Spina Bifida - In-Utero Fetal Surgery Repair
Open and fetoscopic prenatal repair of myelomeningocele, led by Prof. Mauricio Herrera at the Maternal Fetal Institute, Burjeel Medical City.
About Spina Bifida
Spina bifida is a congenital defect in which the spinal column does not close completely around the developing spinal cord. Its most severe form is myelomeningocele, where the meninges and spinal cord protrude through the opening in the back. While most children born with spina bifida survive, they may experience a range of disabilities, including paralysis, challenges with bowel and bladder control, Chiari II malformation, and hydrocephalus (accumulation of excess cerebrospinal fluid in the brain), along with learning disabilities. Generally, the higher the spinal opening is located on the back, the greater the potential for impairment
From Postnatal to Prenatal Repair
Infants diagnosed with myelomeningocele have traditionally undergone surgery shortly after birth to safeguard the spinal cord by closing the congenital opening in the back. In many cases, a ventriculoperitoneal (VP) shunt is also placed to address hydrocephalus.
However, following the success of the Management of Myelomeningocele Study (MOMS), fetal surgery has emerged as a viable treatment option for certain cases of myelomeningocele.
The fetal surgery program for in-utero repair of spina bifida is led by Prof. Mauricio Herrera, with more than 26 years of experience and more than 150 cases of in-utero spina bifida repair.
Our Center Offers Two Techniques
Fetoscopic Spina Bifida Repair
A minimally invasive approach to the repair. Tailored to specific indications and patient conditions such as the size of the defect, the compromise of the skin, and the safe zone for access.
Open Spina Bifida Repair
This procedure is similar to a cesarean section, but the fetus remains in the womb. The neurosurgeon surgically closes the neural tube and other layers of the back. Once the procedure is complete, the incisions in the mother are carefully closed.
Before and After Fetal Surgery
Prenatal repair aims to protect the spinal cord and reverse the downstream effects of the open defect on the brain
Recovery
After surgery, patients will be hospitalized for 4 to 5 days, during which they will receive care from experienced nurses specializing in fetal surgical care.
The fetus will be continuously monitored using ultrasound technology. Following discharge from the hospital, the mother must remain in the local area for a minimum of 10 to 14 days.
The decision regarding travel home will depend on the mother’s condition and the accessibility of medical services in her area.
Components of Fetal Surgery Institute Evaluation
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Fetal anomaly scan — anatomic survey for fetal anomalies.
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Fetal echocardiography for structural analysis of the fetal heart.
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Fetal MRI for a complete evaluation of the fetus: presence and severity of Chiari II Malformation, uterine anatomy, placental anatomy.
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Consultation with our multidisciplinary team: Fetal Surgery specialist, anesthesia, neurosurgery, pediatric surgery, nursing, neonatology, and social work.
Candidacy
Inclusion Guidelines
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Spina bifida defect must start between T1–S1 (may extend below S1)
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Fetal brain changes secondary to the spina bifida: Chiari II malformation
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Normal fetal karyotype
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Gestational age at referral between 24 to 28 weeks
Exclusion Guidelines
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Multifetal pregnancy (twins, triplets, etc.)
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Maternal contraindications to surgery or anesthesia
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Morbid obesity
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Kyphosis (curve in the spine) in the fetus ≥ 30°
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Other fetal problem not related to the spina bifida
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Current or planned cerclage or documented history of incompetent cervix
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Short cervix (< 20 mm)
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Preterm labor in the current pregnancy
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Placenta previa or placental abruption
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Maternal-fetal isoimmunization
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Uterine anomaly
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Inability to comply with travel or follow-up
For Appointment or Referral
Patients who wish to consider fetal surgery at the Fetal Surgery Institute at Burjeel Medical City, Abu Dhabi, UAE, for the treatment of spina bifida, and providers making a referral, please contact us.
Phone
+971 50 118 5243