Texas Children’s Celebrates 10th Anniversary Of Pioneering Fetoscopic Neural Tube Defect Repair

HOUSTON (Aug. 9, 2024) — Texas Children’s Hospital is proud to celebrate the 10^th anniversary of a novel treatment: the laparotomy-assisted, two-port fetoscopic closure of a neural tube defect (NTD) to treat spina bifida. This procedure, pioneered by Drs. Michael A. Belfort, Obstetrician and Gynecologist-in-Chief, and William E. Whitehead, pediatric neurosurgeon, offers the potential for improved outcomes for the baby compared to traditional open repair while also being substantially less invasive for the mother.

The fetoscopic procedure provides a number of significant benefits:

• The opportunity for vaginal delivery in current and future pregnancies, unlike the more extensively used method of open-hysterotomy that involves a large, 7-10 cm. incision in the uterus and requires a cesarean delivery for the index and all future pregnancies.
• Reduced risk of uterine rupture compared to the open-hysterotomy approach.
• Longer gestation, with an average delivery of 36 – 37 weeks.

“Fetoscopic repair of spina bifida offers compelling benefits for both the baby and the mother,” says Belfort. “Repairs performed via open-hysterotomy always require a preterm cesarean birth and often result in the baby being born before 34 weeks. Fetoscopic repair allows the mother the potential to carry her baby to term and have a normal vaginal birth without requiring a cesarean section. A baby delivered at term needs less time in the neonatal intensive care unit and has significantly less chance of needing mechanical ventilation.”

Texas Children’s was the first institution in the world to show that NTDs can be safely and effectively closed fetoscopically using a two-port approach, and it is still one of just a few centers in the country (and world) that offer this type of repair. This procedure has been successfully performed by our multidisciplinary team in over 200 mothers with an average gestational age at birth of 36-37 weeks. The surgery was initially regarded as experimental (2014 - 2022) and was closely monitored by the FDA, but since 2022 Texas Children’s has offered this in-utero surgery as standard of care based on experience and consistent outcomes. Our fetal surgery division and key members of this program (Dr. Magdalena Sanz Cortes, Dr. Roopali Donepudi and Dr. Ahmed Nassr) have extensively reported in scientific papers the outcomes related to those patients who have undergone fetoscopic NTD repair, validating the safety and advantages for the mother and baby using this approach.

“This milestone validates that we are a mature program, that we have done a lot of these cases, and that our results are equivalent to, if not better than, anyone else out there doing this,” Belfort said. “We pride ourselves on offering our patients and families the highest levels of quality, safety and outcome.”

During the procedure, surgeons expose the mother’s uterus through an incision that is slightly larger than a cesarean section scar, the uterus is accessed through two very small incisions to hold scopes and instruments. After some of the amniotic fluid is removed, it is replaced with carbon dioxide gas. Two ports are inserted into the uterus through which a fetoscope and other instruments inserted into the uterus to allow the surgeons to visualize and repair the NTD. Following the repair the exteriorized uterus is repositioned in the mother’s abdomen, the incision is closed, and normal gestation is resumed.

Belfort and Whitehead developed their technique using a simulator made up of a plastic kickball (replicating the uterus) and a baby doll placed inside it (acting as the fetus). Once the technique was developed and refined in the simulator they performed it first in a sheep fetus model and only once it was shown to be feasible and safe was it offered to human patients. 

Grayson Canezaro was the first patient in the world to undergo the two-port fetoscopic procedure. He and his mother, Althea, underwent the surgery at 23 weeks gestation. Today, Grayson is doing remarkably well. He never developed hydrocephalus and is able to walk with orthotics.

Image

This procedure was developed by Texas Children’s Fetal Center, in partnership with Texas Children's Division of Neurosurgery. “The multidisciplinary collaboration with the Fetal Center on this surgical effort is an extraordinary example of the innovative spirit at Texas Children’s Hospital,” Whitehead said. “We have developed a solid relationship between teams and feel very comfortable with each other. We always use the same team— maternal-fetal medicine specialists, pediatric neurosurgeons, pediatric surgeons, anesthesiologists, and highly skilled operating room nurses and surgical technicians — performing the same steps over and over again, which ensures we know exactly what to do every time, and this improves outcomes.”

Spina bifida is the most common NTD in the United States. Characterized by the incomplete developmental closure of the back over the spine and spinal cord, it affects approximately 1,500 of the more than 4 million babies born in the country each year and presents with a wide range of severity. NTDs are usually associated with leg weakness and hydrocephalus, the buildup of cerebrospinal fluid in the brain. Children with spina bifida commonly have abnormal bladder, bowel, and leg function, as well. Repairing the NTD prenatally, whether in a traditional open hysterotomy or fetoscopically, reduces the extent of leg weakness and lowers the risk of hydrocephalus.

“From a medical standpoint, we have definitively shown that closing the defect both in-utero and fetoscopically is a less invasive procedure for the mother, reduces her risk of preterm delivery and reduces the child’s need for a shunt,” said Belfort. “I’m incredibly grateful to have the opportunity to take what we’ve developed and share that knowledge with other institutions for the benefit of everyone.”

Over the past 10 years, Belfort and his team have trained other fetal surgeons and helped open a number of fetal centers throughout the United States and across the world to develop their spina bifida repair program, enabling a safer approach to fetal surgery and ensuring a healthier, happier future for families across the globe. 

ABOUT TEXAS CHILDREN’S HOSPITAL

Texas Children’s, a nonprofit health care organization, is committed to creating a healthier future for children and women throughout the global community by leading in patient care, education and research. Consistently ranked as the best children’s hospital in Texas and among the top in the nation, Texas Children’s has garnered widespread recognition for its expertise and breakthroughs in pediatric and women’s health. The system includes the Texas Children’s Duncan NRI; the Feigin Tower for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston and Texas Children’s Hospital North Austin, the new state-of-the-art facility providing world-class pediatric and maternal care to Austin families. The organization also created Texas Children’s Health Plan, the nation’s first HMO focused on children; Texas Children’s Pediatrics, the largest pediatric primary care network in the country; Texas Children’s Urgent Care clinics that specialize in after-hours care tailored specifically for children; and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is affiliated with Baylor College of Medicine. For more information, visit https://www.texaschildrens.org.