Spina Bifida

Breakthrough Procedure Performed at Sheba: Intrauterine Surgery to Repair Spina Bifida

In 2019, for the first time ever, intrauterine surgery was performed at Sheba to repair spina bifida in a fetus when the woman was in her 25th week of pregnancy.

Spina bifida is a birth defect in the neural tube, which occurs when the spine and spinal cord don’t form correctly. The neural tube is the embryonic structure that eventually develops to become the baby’s brain, spinal cord, and surrounding tissues. Spina bifida can be mild or severe, depending on the type and size of the defect. As a result of this neural tube defect, there can be complications in the fetal brain, such as herniation of the brainstem and enlarged ventricles. After birth, in a majority of cases of spina bifida, the newborn requires a brain shunt and suffers from serious motor disability.

In the particular case of this woman, spina bifida was diagnosed when she was 20 weeks pregnant. After a detailed evaluation done with the aid of ultrasound and MRI, her doctors recommended that she undergo a new type of endoscopic surgery to repair the defect. The woman and her husband consented to this advanced procedure, and the Sheba staff began extensive preparations for the surgery. Over the course of several weeks, they consulted with doctors from the Texas Children’s Hospital in Houston, TX, including Dr. Michael Belfort, the physician who pioneered this surgical method.

Gynecology and Maternity

Prof. Eyal Sivan

A multidisciplinary team at Sheba helped to plan for the surgery, including the directors of the Gynecology and Maternity Division, Prof. Eyal Sivan and Prof. Shalev Mazaki, and leading members of the Fetal Medicine Unit, Prof. Yoav Yanon, Prof. Shlomo Lipitz, Prof. Boaz Weiss, Dr. Hagai Avnet, and Mrs. Iris Horowitz. In addition, Dr. Jacob Zauberman, pediatric neurosurgeon, Dr. Gil Har-Zahav, pediatric surgeon, Dr. Dina Orkin and Dr. Arkady Shraga, anesthesiologists, Dr. Eldad Katorza, imaging expert, and surgical nurses Ms. Aviva Asher and Ms. Dekla Pasternak collaborated to ensure that the hospital facilities were fully ready for the cutting-edge procedure.

When the woman reached her 25th week of pregnancy, the operation was performed. Three physicians from the Texas Children’s Hospital travelled to Sheba to assist. During the surgery, two trocars were used to make an abdominal opening to access the uterus and conduct amniocentesis, CO2 gas extraction, and endoscopic repair of the spinal defect. The operation proceeded normally, and after discharge, the woman was monitored weekly in the Fetal Medicine Unit.

Follow-up imaging tests showed significant improvement in cerebral herniation. At 30 weeks of pregnancy, the woman was hospitalized for low amniotic fluid, and at 31 weeks + 4 days, she gave birth to a healthy baby girl (1677 grams) via C-section. The infant was hospitalized and monitored after birth, and no complications were detected. Now, the child is nine months old, with normal leg mobility and no need for a brain shunt.