Surgeons in Dubai corrected the defective spine of an unborn Emirati baby in the first procedure of its kind in the region.
An operation to rectify myelomeningocele, a form of spina bifida, is usually completed once the baby is born.
But surgeons at Latifa Hospital for Women and Children took the unusual step to perform surgery on a male foetus only 25-weeks old inside a Emirati mother, 24, from Fujairah.
The delicate six-hour operation on the 700 gram unborn baby was a success, offering him the best chance of walking unaided and growing without lower limb deformities usually associated with the condition.
“The patient was referred to us when she was 24 weeks pregnant after her condition was diagnosed in an ultrasound,” said Dr Muna Tahlak, a consultant in obstetrics and gynaecology.
“We immediately conducted a complete foetal evaluation to determine whether the patient was eligible for this kind of intrauterine procedure.”
That included an ultrasound, foetal echocardiogram to check the baby’s heart and MRI scan to understand the type and depth of spinal lesion.
The mother, who already had two healthy children, was given counselling and other available medical options before preparing her for surgery.
“I wanted to do everything possible for my baby’s well-being,” said the mother, who did not want to be named.
“I want him to be a healthy boy and lead a healthy and happy life.
“I am very thankful to the full team for everything they have done for my little boy and me.”
The surgery required extreme precision and was very delicate, doctors said.
It required opening the uterus, which was a different procedure from a Caesarean section.
An incision from the back of the uterus was done in layers, without opening the membrane containing the protective amniotic fluid and foetus.
Surgeons meticulously opened the membrane, then used specialist tools to extend the incision to access the six centimetre lesion on the baby's spinal cord that needed repair.
That allowed neurosurgeon Dr Mohammad Al Olama to correct the defect in a separate, 50-minute procedure.
Only 12 countries in the world are currently performing this type of surgery.
“This is an extremely delicate but important procedure to correct existing deformity, prevent further deformity and help the baby grow,” said Dr Al Olama.
“It allows the baby to develop organs inside the womb without any complications so that it can be as healthy as possible when born.”
Traditionally, the defect is repaired during the first days after birth.
But studies have shown that corrective surgery between 22-25 weeks of gestation in an unborn foetus increases the chance for the child to walk.
It can also avoid further “shunt” operations for hydrocephalus, an accumulation of fluid in the brain, and other complications.
“When the procedure is done after the baby is born, usually the baby does not have a chance to walk as the damage is too late to rectify,” said Dr Al Olama.
“There are very few foetal surgery centres in the world and to have such a kind of advanced surgery.”