Doctors Call Brain Surgery on Baby in Womb a Success

Surgeons opened a woman’s uterus and performed brain surgery on a fetus in March to relieve a buildup of water on the brain, a surgical first, doctors said Friday.

The baby was born two months later showing no signs of congenital hydrocephalus, or water on the brain, Dr. Joseph Bruner and Dr. Noel Tulipan said Friday at Vanderbilt University Medical Center.

The doctors said they have used the procedure 49 times over the last two years to repair spina bifida lesions in the womb. They said it was the first time the procedure was used on the brain.

They acknowledge they won’t know for six months to a year--until they can measure Neal Borkowski’s IQ--whether he suffered any serious brain damage but say “he’s developing now like a normal baby would.”

“We really have to hedge our bets as to how he’ll do over the long run,” Tulipan said. But the fact that he was born without excess fluid on the brain makes the March 2 surgery a success, he said. Neal was born May 12.

The baby’s mother, Susan Borkowski of Knoxville, said she learned during a routine ultrasound that her 20-week-old fetus had hydrocephalus. About one in every 2,000 babies is born with congenital hydrocephalus, and most are severely brain damaged.

“It wasn’t really a decision,” she said of the choice to try the experimental surgery. When she was 6, her brother died of hydrocephalus shortly after he was born, she said.

In the procedure, Borkowski’s uterus was opened by Bruner, then Tulipan made an incision in the fetus’ skull and placed a shunt, or small tube, in the fluid space of the brain.

The opposite end of the shunt was hooked to a small valve controlling the flow of fluid. The valve was connected to another long, thin tube that was tunneled out through the baby’s skin between the shoulder blades and the fluid drained into the amniotic fluid in his mother’s uterus.

The infant was delivered by Cesarean section five weeks early, weighing 4 pounds, 7 ounces. A second operation was performed to exchange the tube for a shunt draining the fluid into his abdominal cavity.

Left untreated, the child most likely would have been born with an enlarged head filled with fluid and almost no brain function.