Cleveland Clinic performs its first in utero surgery on fetus, repairs spina bifida before baby’s birth

Posted at 3:32 PM, Jun 19, 2019

CLEVELAND -- The Cleveland Clinic has joined other top hospitals in North America and can now offer in utero surgery. The hospital announced Wednesday that after more than a year of preparations they have successfully completed Northern Ohio’s first ever surgery on a fetus inside the uterus to repair spina bifida.

“The operation on the fetus in the uterus, I’m directing and in charge of, and the guidance of where we should open the uterus, the exposure of the baby,” said Dr. Darrell Cass, Director of Fetal Surgery in the Cleveland Clinic’s Fetal Center.

Cass and a team of more than a dozen other specialists including pediatric neurosurgeons, a fetal cardiologist and pediatric anesthesiologists performed the surgery on a nearly 23-week fetus with the birth defect spina bifida in February.

The baby girl was born at nearly 37 weeks on June 3. Both the mother and child are doing well. In a fetus with spina bifida, the tube that typically protects the lowest part of the spine fails to close leaving the spinal cord exposed, causing a myriad of problems.

“Spina bifida leads to disability in a baby, it can cause paralysis of the legs, it can effect their ability to urinate,” Cass said. “A build-up of pressure and fluid and that pressure can lead to brain damage."

Fetal surgery for the birth defect is currently an option for parents in about 20 hospitals in North America after becoming clinically accepted in 2011. Prior to 2011, there were only four fetal surgery centers in the world. Cass was the director of one of them.

Cass has performed more than 160 fetal surgeries since 2002 and after 17 years as the co-director of Texas Children’s Fetal Center in Houston he joined the Cleveland Clinic to begin the fetal surgery program. He and his team spent more than a year preparing for their first surgery.

“We started doing simulations and walk-throughs and preparations for how the operations would go how the family’s experience would be,” Cass said.

The team also visited other fetal surgery centers around the country to learn from the top experts in the field.

While the mother is doing well, she isn’t ready for an interview. She allowed the hospital to share video of the surgery.

“We open the uterus in the smallest way directly over where the baby’s back is positioned,” Cass said. The team uses ultrasound to constantly monitor the baby’s position during surgery.

Doctors repair the baby’s spine through an opening in the uterus just 4.5 centimeters wide.

When the surgery is finished, “her spinal cord is completely protected,” Cass said. “It’s covered with muscle and skin, something called a myofascial repair, which is the current state of the art."

Cass explained the surgery is extremely risky for the baby; there is potential that the mother delivers the child in the immediate weeks following the surgery.

But in this case the mother carried the child nearly to term, 36.5 weeks, allowing the baby’s brain to be more fully developed, before giving birth by C-section.

“The operation went perfectly, and in fact the repair on this baby’s back is the best that I’ve seen in the last 20 years,” Cass said.

Spina bifida cannot be cured entirely, but the little girl will have fewer disabilities and a much better future and quality of life than if she had been treated after she was born.

“She will still have to deal with some disability and we are going to work on all of those things but she will be as good as she can be,” Cass said.