Riley surgeons perform Indiana’s first spine surgery on fetus inside the womb

Surgeons at Riley Children’s Hospital in Indianapolis performed the state’s first successful fetal spinal surgery on a severe spinal cord defect.

The surgical procedure makes the hospital one of only a handful of places nationwide that offer this procedure. 

Children born with myelomeningocele — a severe form of spina bifida in which the bones of the spine do not fully form during pregnancy exposing the nerves and membranes — can experience problems like learning difficulties, seizures, fluid builldup in the brain, paralysis and bowel dysfunction.

Outcomes are better if children are operated on before birth — inside the mother’s womb.

The procedure is still relatively new. Prenatal surgeries first started in the 1980s. An influential study in 2011 underlined that doing the surgeries in the womb pre-birth resulted in better outcomes for children. 

But that operation, called open repair, is invasive and can lead to maternal complications. To do it, surgeons make a roughly eight-centimeter incision into a mother's abdomen. From there, doctors open the uterus in order to operate on the fetus.

Hiba Mustafa, the director of fetal surgery at Riley and the co-surgeon on the procedure, said their highly specialized method uses smaller tools and an incision roughly half the standard size, which improves outcomes for mothers.

“So, [mothers] used to have uterine rupture. Now that risk does not exist,” she said. “They used to need a C-section for every delivery, and now our patient can do vaginal delivery, and their maternal recovery is faster.”

According to Mustafa, that specific method places Riley among a limited number of institutions in the world that do the surgery this way.

“It's very exciting, not only for us, but for the families we care for here in Indiana,” she said.
 

Once fetal surgeons make the incision, pediatric neurosurgeon Jason Chu takes care of the nerves that protrude from the fetal spine in utero.

“My role is to help free up and protect those nerves that didn't form, as well get them back into a more normal space within the body, and then help get them covered up as best as possible,” Chu said.

Not every mother and fetus with spina bifida is eligible for the procedure. Exclusions can include other severe fetal anomalies, uterine anomalies for the mother, or morbid obesity. 

The hospital has performed the procedure four times already with three more scheduled. 

“This is just an exhilarating feeling, being able to complete these fetal surgeries for these babies with spina bifida and myelomeningocele,” Chu said. “It's been just amazing being part of this team and helping out a lot of these patients as well as their families.”

Both Chu and Mustafa noted that their work was only possible because of a large team at Riley helping to support them.

Contact health reporter Benjamin Thorp at bthorp@wfyi.org.