fetal surgery for spina bifida | Mexico, a pioneer in fetal spina bifida surgery

 



Mexico, a pioneer in fetal spina bifida surgery


This embryonic defect that causes motor disability occurs in one in every 1,000 pregnant women and it is estimated that 250,000 new cases are presented each year in the country.
Avatar of Nelly Toche Nelly Toche March 08, 2017, 7:55 PM
Share

Until recently in our country fetuses were not visualized as patients. The anomalies or malformations were considered diseases that should be treated after birth. This was what prompted a team of doctors led by Dr. Rogelio Cruz Martínez to create the Fetal Surgery Unit, unique in Mexico and Latin America.

Thanks to the Neurodevelopment Research Unit of the Institute of Neurobiology of the UNAM Campus Juriquilla, the Kristen Foundation and the Hospital of Specialties of the Child and Women of Querétaro Dr. Felipe Núñez Lara, this pioneering project in Mexico began to operate from In 2012 and to date, they have performed around 400 surgeries to treat from the uterus.

However, in 2016, these specialists designed the national intrauterine correction of spina bifida, a non-fatal but disabling disease.

Today, fetal neurosurgery to correct in the uterus spina bifida is a reality in our country. The first three cases of success were presented by the team consisting of eight Mexican specialists from the Fetal Surgery group of Querétaro and three specialists from the Fetal Surgery team of the Las Condes Clinic in Santiago de Chile.

The first intervention was to a fetus of 26 weeks; a second successful fetal surgery was performed, and on February 21 and 27, 2017, 11 and 12 weeks after the respective interventions, the first two babies were born via cesarean section, at 35 and 38 weeks of gestation, without complications.

After the fetal surgery, a follow-up was performed and a fetal magnetic resonance was performed, which verified motor movements in both legs and the disappearance of spina bifida and hydrocephalus.

Both children presented a perfect healing in the lumbar area, where the defect was corrected surgically, and an adequate mobility of both legs. Two days after birth they were discharged, Cruz Martínez said.

The babies were enrolled in the neonatal neonatal program, designed by Thalía Harmony, director of the Neurodevelopment Research Unit, where they undergo specialized tests to assess neurological, cognitive, visual, auditory and motor development.

The third intervention was with the exclusive participation of Mexican specialists, it was operated on February 9 of this year, at 25 weeks of gestation, continues its pregnancy without complications and has a current gestational age of 29 weeks.

What is spina bifida?

Spina bifida or myelomeningocele is an embryonic defect in the closure of the neural tube, which causes the nervous tissue of the spine to be exposed in the spinal column.

The fetus has a protuberance in the lower part of the spine that, when it hits the mother's uterus, causes irreversible damage.

It is a disease that causes motor disability, hydrocephalus, neurological damage, urinary and fecal incontinence, and in most cases motor disability of the legs.

This disease is the main cause of disability in Mexico. According to the specialists, it occurs in one of every 1,000 pregnant women and it is estimated that 250,000 new cases will be presented each year in Mexico.

Until now, a repair was done in layers once the baby was born, but often there were cases where they were condemned to a wheelchair.


Today, the surgery consists of a kind of cesarean, in which many doctors participate; the baby must be in an upside down position in order to operate the spine, the specialist explained. The fetus is anesthetized and it is reached through an incision in the uterus of the mother.

The criterion for the selection of the babies was that they presented isolated defects, without chromosomal or genetic abnormality, and with affection above the first sacral vertebra, hydrocephalus and Arnold Chiari II malformation to be able to intervene between 20 and 26 weeks of gestation.

Happy mothers

From Sonora, Querétaro and Mexico City, Ana Harumi Hayashida Carrillo, 42; Maricela Pacheco Velázquez, 27, and Alma Yesenia Quintero, 34, approached this group of doctors with the sole intention of finding an opportunity for their babies.

The news is overwhelming, and we thought about how the baby's life would be, said Ana, who is waiting for the birth of her baby: When we learned about the benefits of surgery it was a great hope, a great blessing to have found Dr. Cruz and his team just in time.

Today seeing these little ones by my side gives me hope that my baby will have a similar result.

The operations were free, thanks to the support of the Kristen Foundation. This has been a relief for the families of these children, since the costs of the interventions amount to more than half a million pesos each, plus the rehabilitation that is required after the operation.

In Mexico, this research group is the first to perform many of the possible fetal procedures. They have received patients from other countries and have sought treatments that had not been done anywhere in the world. To date, three of its procedures are totally innovative and were published in international journals, Fetal Diagnosis and Therapy and the journal of the International Society of Fetal Surgery.

Today Ian Gael and Iker Alonso are the first beneficiaries of this effort that began with a small group of doctors concerned about this specialty, which still lacks sufficient medical equipment, so today this specialty is promoted through the Hospital de Especialidades del Child and Women in Queretaro and is registered in the National Quality Postgraduate Program (PNPC).