The Center for Prenatal Pediatrics is a leader in innovative treatments for fetal spina bifida. Our world-class team of maternal-fetal medicine specialists works closely alongside surgical and obstetric anesthesia specialists to ensure the best possible outcome for you or your patient.
- Multidisciplinary Fetal Therapy Team: Our team consists of maternal-fetal medicine, pediatric surgery, pediatric neurosurgery, and obstetrical anesthesia subspecialists. We meet regularly with patients and their families to help them better understand their specific diagnosis and its implications, as well as which options are available to them. Together, we work to determine the best course of action for each individual presentation.
- Minimally Invasive Surgery: We believe that a minimally invasive approach (small incisions on the uterus), also known as a fetoscopic approach, provides an advantageous balance of maternal, fetal, and obstetrical risks and benefits. This approach intends to maximize fetal outcomes, while ideally minimizing risk to the mother and subsequent pregnancies.
- Pre-operative Screening & Counseling: For patients who are interested and suitable candidates for prenatal surgery, we work with them to derermine if this is the right decision for them and guide them through this treatment option.
About Spina Bifida
What is spina bifida?
Spina bifida is the most common type of neural tube defect (NTD), which is a birth defect involving the brain and spinal cord. A severe form of spina bifida, known as myelomeningocele, results in a sac-like lesion along the spine where the spinal cord and the nerves are open and exposed to the amniotic fluid. Less serious forms of spina bifida are meningocele — in which the spinal cord itself is not damaged but its protective covering is exposed — and spina bifida occulta — in which only the bones of the spine are malformed but the nerves and spinal cord are normal and covered by skin. Spina bifida occurs in approximately three out of every 10,000 live births.
What are the outcomes of spina bifida?
Spina bifida is associated with long-term complications that may include paralysis, inability to walk, gait abnormalities, excess fluid on the brain (hydrocephalus), neurocognitive delays, spinal deformities, postural issues, neurocognitive disability, and incontinence.
The long-term prognosis, including the degree of disability, is largely dependent on where along the spine the nerves were damaged, the size of the lesion, whether other birth defects are present, and how the spina bifida is treated. In general, the lower the lesion is along the spine, the better the outlook. Hydrocephalus is also a major factor impacting prognosis. A surgically placed shunt (also known as a VP shunt, or ventriculoperitoneal shunt), may need to be placed to help drain excess fluid in the head and relieve pressure on the brain. However, shunts can be a serious cause of morbidity in patients, as they can be associated with infection, malfunction, and repeated surgical interventions.
What treatment options are there?
Until recently, spina bifida could only be treated with postnatal (after birth) surgery to close the spine within the first few days of newborn life. However, in 2011, results from the MOMS trial, a large multicenter randomized control trial comparing outcomes of prenatal (before birth) versus postnatal surgery for myelomeningocele were published. This study demonstrated that pre-natal surgery (surgery on the fetus prior to delivery) for myelomeningocele improved overall pediatric outcomes. Specifically, prenatal surgery reduced the need for VP shunt placement, improved the ability of patients to walk independently, and was associated with improved neuromotor development. Notably, prenatal surgery was associated with certain maternal and obstetrical health risks.
Patients wishing to make an appointment or physicians wishing to refer a patient to speak with a fetal therapy specialist at the Center for Prenatal Pediatrics at Columbia University can call 877-843-2229.