A surgery performed while she was in her mother’s womb saved three-month-old Eiko Son from a lifetime of impairments from spina bifida.
The team of fetal specialists, neurosurgeons, cardiologists at Mount Sinai Hospital in Toronto performed a two and a half hour operation to close the opening in Eiko’s spinal column that would have left her with life long motor and nervous system impairments.
Eiko’s mother, Romeila, was 26 weeks pregnant when doctors cut into her womb to repair her unborn baby. She carried to term and gave birth to her healthy daughter on August 19.
The innovative in utero spina bifida surgery was done by the first time in 1997 at Vanderbilit, and is still only performed at a few top hospitals in the world.
Surgeons cut into Romeila Son’s (right) womb to operate on the spine of her unborn daughter, Eiko (center) in order to fix the baby’s spina bifida in June. The surgery was a success and Romeila and Eiko’s father, Romeo Crisostomo (left) had Eiko, now three months old, in August
Between 1,500 and 2,000 babies are born with spina bifida each year in the US.
The birth defect is a type of neural tube defect, meaning it affects a baby’s brain, spine or spinal cord. In spina bifida, the neural tube fails to close somewhere along the spine, leaving an opening in the spine, and the spinal cord and nerves vulnerable to trauma and damage.
The condition develops during the first month of a mother’s pregnancy, often before she even knows that she is expecting.
A diagram shows how doctors had to cut through Romeila’s abdomen and uterus to access her baby’s spine and repair the opening in it
Depending on where along the backbone the opening is, children born with spina bifida may have mild or severe physical disabilities and may need lifelong care and support. The disease can also cause intellectual impairments.
The condition develops during the first month of a mother’s pregnancy, often before she even knows that she is expecting.
Romeila’s doctors discovered that the baby she was carrying had myelomeningocele, which is the rarest, most debilitating and most publicized form of spina bifida.
Myelomeningocele may cause either a bulge under or even an opening in the skin of the babies back, where nerves are protruding out of the spinal canal and can easily be damaged.
If Romeila had carried her daughter to term, Eiko would most likely have needed a procedure to relieve pressure in her brain, likely would not have been able to walk independently, and may not have lived to adulthood.
Instead, Romeila’s team of surgeons and nurses – including the Vanderbilt University surgeons that developed the surgical technique – performed a delicate surgery to close opening in Eiko’s back that may otherwise have debilitated her for life.
Dr Noel Tulipan and his team at Vanderbilt performed the first ever maternal fetal surgery to correct spina bifida in 1997. A clinical trial was stopped short of its planned run in 2003, when it was glaringly obvious that outcomes from the in utero surgery were more than 80 percent better than for children who received the operation after birth.
Vanderbilt immediately began offering the procedure to its patients, and Dr Tulipan has now done more than 200 such operations at his hospital and others. A slowly growing number of top hospitals now offer the surgery too.
To do the procedure, the team had to put Eiko – still a fetus at the time – under anesthesia, sedate her, and temporarily paralyze her.
Spina Bifida is a birth defect in which there is an opening along a baby’s spine, exposing the nervous system to damage. After an in utero operation, the nervous tissue is protected and the spine is covered
Romeila’s surgeons placed a cover on the exposed nerve tissue of her baby’s back, before closing the skin of the back over it (pictured)
Then, they cut through Romeila’s abdomen and uterus to reach the baby for the neurological portion of the surgery.
Carefully managing the amniotic fluids that protect a fetus, the doctors freed the developing nerves in her back from the open skin, placed a patch over the nerve tissue, and sewed the skin closed. The entire neurosurgery aspect of the operation took just 25 minutes.
Eiko was born 10 weeks later, three weeks before full term, on August 19.
Babies who underwent in utero surgery are at greater risk of premature birth, but operations like Eiko’s reduce risk of the need for brain shunts or aid walking by half, and reverses one third of abnormal brain developments.
Romeila was the first mother to be able to have the rare in utero surgery in her home-country of Canada. Romeila has made a full recovery, and she and Eiko’s father, Romeo Crisostomo will celebrate three months with their healthy baby girl on November 19.