April 28, 2011

Panel explores fetal surgery program’s history, milestones

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Joseph Bruner, M.D., center, took part in a panel discussion on fetal surgery with Ray Paschall, M.D., left, Noel Tulipan, M.D., and others. (Photo by Mary Donaldson)

Panel explores fetal surgery program’s history, milestones

Joseph Bruner, M.D., returned to Vanderbilt University Medical Center last week, where 14 years ago he helped pioneer fetal surgery to treat a severe form of spina bifida.

Bruner, who is now in private practice in Odessa, Texas, participated in an Obstetrics and Gynecology Grand Rounds panel discussion moderated by Frank Boehm, M.D., vice chair of the department, along with the other pioneers of Vanderbilt's fetal surgery program — Noel Tulipan, M.D., Ray Paschall, M.D., and Mark Bliton, Ph.D., representing Neurosurgery, Anesthesiology and Ethics, respectively.

Bruner, who led the multi-disciplinary fetal surgery team with Tulipan, recalled scrubbing at the sink prior to many of the early surgical procedures and being so nervous that he “wanted to go home, get in the bed and pull the covers over my head.”

He said since so much was unknown about fetal surgery at that time, he was afraid of injuring the patient, the fetus and his personal reputation. Although spina bifida, the most common birth defect of the central nervous system, is disabling, it's not a lethal birth defect, and many critics said the risk of performing such procedures for a non-lethal condition was too great.

Tulipan told the packed room in Light Hall that he performed the in utero procedure as he would repair the defect in a newborn.

“So I felt very confident I could do that. For me, it was fun and exciting, not terrifying,” he said, smiling at Bruner.

Recent results of a landmark, seven-year National Institutes of Health-funded trial, Management of Myelomeningocele Study (MOMS), in which Vanderbilt was one of three participating centers, demonstrated clear benefit for babies receiving in utero repair of myelomeningocele, a severe form of spina bifida.

The study validates a prior 1999 JAMA study by Bruner and Tulipan showing these babies have an increased chance of walking and are less likely to suffer from hydrocephalus (build-up of fluid on the brain that requires a shunt).

The Vanderbilt team pioneered the procedure in 1997, and has since performed more than 200 fetal repair surgeries.
Vanderbilt operated as a trial site in the MOMS study, and performed 177 repairs prior to the study.

The panel discussion was attended by many past and present members of the fetal surgery team.

“When I think about what our team did, and one-third of the people in this room were part of that team, I'm so grateful to be back with the group that made this possible,” Bruner said.