Cleveland Clinic performs its first in utero fetal surgery, making strategic move into prenatal care

CLEVELAND, Ohio – The Cleveland Clinic completed its first in utero fetal surgery to repair a spina bifida birth defect earlier this year on a 23-week-old fetus, bringing a new surgery option to northern Ohio.

The surgery was in February. The child, a baby girl, was delivered via cesarean section June 3.

“By successfully repairing the defect before birth, we’re allowing this child to have the best possible outcome and significantly improve her quality of life,” Dr. Darrell Cass, director of fetal surgery in the Clinic’s Fetal Center, said in a prepared statement. “There are different measures of quality in determining success for fetal repairs and in this particular case, all metrics for maximum quality were achieved.”

The surgery was the first in utero fetal surgery performed at the Clinic’s Fetal Center, which was established two years ago, and the first surgery of its type in northern Ohio. In the past, expectant mothers had to relocate to Cincinnati or one of the other handful of sites in the U.S. that offered the prenatal spina bifida surgery.

“Some have families stay there the entire time while recovering until the baby is born,” Cass said. “I think it’s great there’s now fetal surgery available in northern Ohio. There are a lot of patients in the greater area.”

Roughly 1,600 babies with spina bifida are born each year in the U.S., according to the Centers for Disease Control and Prevention. The defect can affect mental development and motor function and can lead to paralysis. The Clinic’s first surgery was on a baby girl with myelomeningocele, the most common and most severe version of spina bifida.

In the world of medicine, in utero fetal surgery for the spina bifida defect is still relatively new. The first experimental surgeries were conducted in the late 1990s. Then in 2011, the results of a randomized trial were published in the New England Journal of Medicine that showed the benefits of performing the surgery prenatal instead of postnatal (after birth) as was common.

“There’s now scientific proof and evidence that this is [the] best care,” Cass said. “Insurers are paying for it. It’s not experimental; it’s clinical medicine.”

More hospitals, including University Hospitals, perform fetal interventions, which are less invasive operations. But only about 20 sites in the country perform open fetal surgeries for the spina bifida defect, actually opening the uterus to operate on the baby, Cass said.

The Clinic recruited Cass to Cleveland from Texas in October 2017 to create the fetal surgery program. In Houston, Cass co-founded and co-directed the Texas Children’s Fetal Center for 17 years. He has performed more than 160 fetal surgeries and trained in San Francisco, where the first in utero prenatal surgery was performed.

In Cleveland, Cass built up his team and then took them to fetal surgery centers across the country to observe. They also performed simulations to prepare for their first surgery. When they went into the operating room this past February, after a year of preparation, the team of 30 people was ready.

The baby girl was delivered successfully at 36.5 weeks, two weeks after the average date of birth for babies who undergo the surgery, meaning she had more time to develop in the womb.

“You can’t make spina bifida go away,” Cass said. “I’m confident in saying this surgery will allow this baby girl to be as good as she can be with spina bifida. She will have the best chance of having function of her legs and bladder.”

Cass said that his hiring is part of a strategic goal of the Clinic’s to provide full care from the fetus through adulthood. The Clinic, while known for providing world-class care and regularly rated by U.S. News as the nation’s second-best hospital, isn’t often recognized for its pediatric care.

“I think it’s a new era,” Cass said.