Four babies, four families and the hope of four very improved lives
Dr Glen Gardener
Four babies, four families and the hope of four very improved lives, thanks to a sharp team of Brisbane surgeons, providing the only in-utero surgery in Australia and New Zealand to treat babies with spina bifida.
The medical team, led by Mater Centre for Maternal Fetal Medicine director Dr Glenn Gardener, is based at Brisbane’s Mater Hospital and includes neurosurgeon Dr Martin Wood and anaesthetist Dr Aled Hapgood.
They are the only medical specialists in Australia and New Zealand with the skills and experience to perform the delicate surgery, which involves sedating both the pregnant mother and her baby and making an incision in the uterus to access the unborn baby.
Since performing the first surgery in 2016, the team has successfully performed this ground-breaking operation on a total of four unborn babies with spina bifida, with the hope of greatly improving all four of their lives.
“This surgery isn’t a cure for spina bifida, but rather a new paradigm in that we are now operating on conditions to improve the outcomes for these babies, rather than to save their lives,” Dr Gardener said.
“Babies don’t usually die in utero from spina bifida but they can have lifelong complications that we can ameliorate, and there is good evidence that we can reduce the effects of this disability.”
The surgery can halve the chance of these babies being born with fluid on their brain, which requires a tube inserted that drains the fluid from their brain into their abdomen, said Dr Gardener.
These drainage tubes can have lifelong complications and 80 per cent of children born with spina bifida will need one for life.
“The surgery has also been shown to double the chance that the child will walk without assistance, whereas many children with spina bifida have limited mobility and require a walking aids or a wheelchair,” Dr Gardener said.
Spina bifida affects one in every 2000 pregnancies in Australia and it is a condition where the lower part of a baby’s spine does not develop normally leaving the spinal nerves exposed and at risk of damage. The effects can include inability to walk and the need to continuously drain fluid from the brain.
Through this surgery, doctors use skin from the baby’s back to cover the spine and nerves and protect them against the risk of ongoing damage.
It took four years of painstaking research, learning, planning and practising the rare surgery, which is giving families with spina bifida diagnoses renewed hope.
When a baby is diagnosed with spina bifida in utero, many pregnancies end in a termination, or if the baby is born, surgery to close the spinal defect is required but by that stage damage to the spinal nerves has already occurred.
Dr Martin Wood
Neurosurgeon Dr Martin Wood said prior to undertaking the surgery, the team at the Mater had been approached by a number of mothers with spina bifida pregnancies looking for treatment options.
“We had a few mums with spina bifida pregnancies that didn’t want to terminate their pregnancies but were interested in seeing what else was available and were actually travelling overseas to have the surgery at enormous cost and undergoing a major invasive procedure in a foreign country, at great risk.”
The Brisbane team observed and learned the techniques for the surgery from the pioneering US medical team at Vanderbilt University Medical Centre in Nashville, as well as observing doctors in Belgium.
The Vanderbilt doctors travelled to Brisbane to perform the first case successfully with the Brisbane doctors in 2016.
Dr Gardener said once the Brisbane medical team had successfully completed the second surgery without support from the Vanderbilt doctors, the Mater team was confident to perform a third and fourth surgery in quick succession, with mothers and babies travelling to Brisbane from Sydney, Cairns and New Zealand.
“As well as offering a better outcome for four children with spina bifida, Brisbane has demonstrated that we can do something here that very few units around the world can do,” he said. “Most of our fetal surgery is via a ‘keyhole’ approach but with the ability to perform open fetal surgery, there is now no fetal surgery operation that we can’t do in Brisbane.”
Dr Gardener said Brisbane’s strong tertiary institutions meant the medical and research community across the city was world-class.
“In Brisbane we have the population, we have the links to international collaborations and we are players on the international scene.”