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Cleveland Clinic performs its first fetal surgery to repair spina bifida

Surgeons at Cleveland Clinic in Ohio say a baby girl was born healthy after undergoing the hospital's first-ever fetal surgery for spina bifida. The operation repaired the child's spinal birth defect while she was still in her mother's womb.

The team of doctors performed the surgery in February, when the fetus was at 23 weeks gestation. The baby girl was delivered via caesarean section on June 3. Both mother and daughter are doing well after the surgery, Cleveland Clinic says in a statement on their website.

Dr. Darrell Cass, director of fetal surgery at Cleveland Clinic's Fetal Center, led the multispecialty team. Cass has performed more than 160 fetal surgeries for other conditions since 2002. The team prepared for this surgery for more than a year, by visiting other centers, conducting simulations and consulting with other experts in the field. The procedure was pioneered by surgeons at the Children's Hospital of Philadelphia.

Spina bifida is often discovered during routine anatomy scans performed when a fetus is around 18 weeks old, the hospital says. It occurs when a fetus' neural tube does not fully close, affecting the lower spine. The backbone that protects the spinal cord does not form as it should, and it often results in damage to the spinal cord and nerves, or even brain damage.

Children with spina bifida could have trouble walking or running due to their lack of lower leg strength. The birth defect occurs in approximately 1,645 babies born in the U.S. each year, according to the CDC.

Doctors performed the in utero surgery by making a small c-section-like incision. They used an ultrasound to locate the placenta and fetus, and made a small 4.5 cm opening in the uterus to expose the fetus' back. Then, surgeons sutured layers of tissue and repaired the defect.

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A group of doctors prepared for the surgery for a year. Cleveland Clinic

The uterus was then closed and the fetus remained in the womb to continue developing for the remainder of the pregnancy.

"By successfully repairing the defect before birth, we're allowing this child to have the best possible outcome and significantly improve her quality of life," Cass said in the hospital's statement.

The hospital noted that births after fetal surgery occur, on average, at 34 weeks gestation. The baby in this case was born at 36.5 weeks — a positive outcome because it gave the child more time to develop and grow in the womb.  

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Spina bifida affects a baby's spine and makes it harder for children to walk or run. It could also cause brain damage. In this case, the in utero surgery successfully reversed the defect. Cleveland Clinic

Even though the surgery was a success, spina bifida is never fully cured, Cass said. "Moving forward, the baby will require ongoing supportive care provided by a multidisciplinary team of caregivers in our Spina Bifida Clinic, which will involve neurology, urology, orthopedics, developmental pediatrics and neurosurgery, among other specialists."

The team at Cleveland Clinic said the case should offer hope for other patients. "Families in this region now have more options when it comes to making these types of decisions and we are thrilled to be able to provide the care needed for these complex cases," Cass said. 

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