Prof. Dr. Ali EKİZ

Prof. Dr. Ali EKİZ

Gynecology and Perinatology (Risky Pregnancy) Specialist

With over 15 years of professional experience, dozens of national and international research articles, and most importantly, his smiling face, Gynecology and Perinatology Specialist Prof. Dr. Ali EKİZ is with you.

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Spina Bifida Open Fetal Surgery

Spina bifida refers to a situation where the bones that make up the spine do not completely cover the spinal cord, and the spinal cord and associated nerves are therefore exposed.

The word spina bifida comes from the Latin and means “split” or “open” spine. For this reason, it is also known as “split spine disease”. Spina Bifida occurs in one in 3000 live births.

What is Spina Bifida Surgery with Open Fetal Surgery?

Open fetal surgery is the process of performing surgery on the baby’s spine by creating a small opening on the uterus of the baby in the mother’s womb. This procedure is a surgical intervention performed in the womb of the fetus in the period before birth. Open fetal surgery can be performed in some fetuses with spina bifida (Neural Tube Defect). In this article, we have compiled what you need to know about open fetal surgery. 

When and How Is Open Fetal Surgery Performed for Spina Bifida?

The preferred gestational week for open fetal surgery is 26 weeks. We can list the application steps of open fetal surgery as follows:

1. Anesthesia: For open fetal surgery, both spinal anesthesia and general anesthesia are applied to the pregnant woman. For this long-lasting operation, the mother is connected to very special devices and closely monitored.

2. Opening of the anterior abdominal wall: The uterus is reached by opening the anterior abdominal wall, similar to a cesarean section or vertically.

3. Anesthetizing the fetus: By injecting into the vein or muscle of the fetus, the fetus is anesthetized and it is ensured that it does not move. In this way, the fetus does not feel pain during the operation.

4. Uterus (uterus) incision (Uterotomy): After the anesthesia of the fetus, a 5-10 cm long opening is created in the uterine wall. This process provides access to the fetus and makes it possible to perform surgical intervention.

5. Surgical intervention: The spine of the fetus is brought to the area where the opening to the uterus is created and the open part of the spine is corrected by surgery.

6. Closure: All incisions made after the operation of the fetus are duly closed. 

Who is Open Fetal Surgery Applied to?

Open fetal surgery is a more invasive method. Therefore, there are risks on both the fetus and the mother. Open fetal surgery should be performed by an experienced team of fetal surgeons. In each case, the risks and benefits are carefully evaluated and explained in detail to the family.

Open fetal surgery operation In the expectant mother; It carries the risk of complications such as premature birth, uterine rupture, placental bleeding (abruptio placentae) and risk of infection. In the fetus, it carries the risks of cardiac arrest in the womb, premature birth and complications related to preterm birth. For these reasons, pregnant women who underwent open fetal surgery should be followed very closely from operation to delivery, and the team should be on alert for 24-hour emergency intervention.

Open fetal surgery for spina bifida,

• If the open area of the spine is not more than 6-7 segments,

• If the fluid accumulation in the head, namely hydrocephalus, does not exceed 16 mm,

• If there is no curvature (kyphos or scoliosis) in the spine,

• If there is no additional organ anomaly,

• If the genetic examination of the fetus is normal,

• If the pregnant woman does not have a disease that prevents the operation,

• If the pregnant woman is not extremely obese

Applicable. However, the above still constitute the general rules. In terms of suitability for the operation, a detailed organ scan, that is, detailed ultrasound, is made by the Perinatology specialist in the team and the decision is made accordingly.

Should Spina Bifida be operated in the Womb or Postpartum?

This is a question that has not yet been clarified all over the world. However, there are some proven data. Fetuses who had surgery in the womb compared to those who had postpartum surgery; It has been proven by scientific publications that they are less likely to need shunt surgery due to hydrocephalus, half of the cerebellum prolapse, independent walking is 2 times more, and they are in a better functional condition. 

Is Open Fetal Surgery Only for Spina Bifida?

Currently, open fetal surgery is most commonly performed for spina bifida. There are further studies for some other diseases that may be present in the fetus. In the near future, many diseases will be added to the list of open fetal surgery operations.

Some examples of these are given below.

• Fetal lung masses: Masses such as CPAM (Congenital Pulmonary Airway Malformations) and Pulmonary sequestration that may be in the lungs may compress the lungs and heart and require intervention in the womb.

Tumors of the fetus: Tumors can occur in any organ in the fetus in the womb. One of the most common is sacrococcygeal tumors. Tumors may require immediate intervention by growing faster than the fetus in the womb or by causing blood flow disturbance.

MAKE YOUR APPOINTMENT WITH PROF. DR. ALİ EKİZ!

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