In-Utero Repair of Spina Bifida
Spina bifida, meaning "split or open spine," is a condition where the spinal cord and nerves are damaged, leading to various complications. While the exact cause is unknown, factors such as folic acid deficiency, genetic predisposition, exposure to high temperatures during pregnancy, and diabetes have been implicated. Spina bifida can be detected as early as the 12th week of pregnancy. It involves not only an open spinal cord but also various related issues. Approximately 85% of affected infants develop hydrocephalus (fluid accumulation in the brain), alongside bladder and kidney problems, spinal deformities, impaired leg movements, and psychological, cardiac, and gastrointestinal issues.
Prevalence and Early Intervention
Spina bifida affects approximately 1 in 1,000 live births in developed countries. In Turkey, regional variations exist:
- İzmir: 1.5 per 1,000 births
- Elazığ: 2.2 per 1,000 births
- Ankara: 4 per 1,000 births
Early intervention is crucial. Surgical correction performed within the first 8 hours after birth significantly improves outcomes. Hydrocephalus is managed through neurosurgical procedures, while other complications, such as spinal deformities and bladder issues, require orthopedic and urological surgeries. Treatment involves ongoing medical care to ensure a more comfortable life, even if complete health cannot be restored.
Modern Treatment Approaches
The latest and most advanced treatment for spina bifida is in-utero or fetal surgery, which aims to close the spinal defect during pregnancy. This prevents further damage to the spinal cord that begins in the womb and continues after birth.
Types of Fetal Surgery
1. Open Surgery: Performed similarly to a cesarean section, where the uterus and fetal spine are exposed for direct surgical repair.
2. Fetoscopic Surgery: A minimally invasive procedure using three 3mm instruments to access the fetus through a small uterine incision. The exposed spinal cord is carefully covered with a natural membrane and sutured to prevent amniotic fluid damage.
Fetal Surgery in Turkey
In 2014, the Spina Bifida Application and Research Center at Istanbul Bilim University became the first in Turkey to perform fetoscopic spinal repair. After two years of preparation, the team successfully treated four fetuses, resulting in significant reductions in hydrocephalus and preservation of leg movements. This technique, also used in Germany, Spain, and Brazil, represents a milestone in Turkish medicine.
Additional Applications of In-Utero Surgery
Fetal surgeries are not limited to spina bifida. They are also used for conditions such as:
- Urinary tract obstructions causing bladder and kidney enlargement.
- Diaphragmatic hernia, where abdominal organs enter the chest cavity due to missing respiratory muscles.
- Twin-to-twin transfusion syndrome.
- Certain tumors and fluid accumulation in the fetal chest.
Early interventions improve survival rates for fetuses with life-threatening congenital conditions.
Significance of Fetal Surgery in Turkey
The first fetoscopic surgery in Turkey, performed at Istanbul Bilim University, has elevated the country’s medical capabilities to a global standard, paving the way for healthier future generations. The multidisciplinary team at the Spina Bifida Application and Research Center continues to prioritize providing the best care for children, reinforcing their role as a pioneer in this field.
