Cincinnati Children’s Fetal Care Center is one of the few existing comprehensive fetal centers worldwide. The center takes its collaborative efforts a step further, however, with a partnership among its fetal surgeons, fetal neurologists, fetal neurosurgeons and fetal radiologists. 

These providers routinely work together to provide the potentially lifesaving care many babies with complex fetal conditions need both before and after birth.  

“The collaborative nature behind the way we provide care for our families is unique,” says Charu Venkatesan, MD, PhD, associate professor and fetal and neonatal neurology specialist. “We bring together our maternal-fetal medicine specialists, neonatologists, geneticists, social workers, and, when needed, our sub-specialists. It all enhances the experience for our patients and our referring physicians.”  

The Collaborative Benefits for Surgical Intervention

Currently, thanks to our neurology-neurosurgery partnership, the Fetal Care Center is a leader in offering minimally invasive surgery for myelomeningocele (MMC), according to Foong-Yen Lim, MD, professor and Fetal Care Center surgical director. It both increases a child’s chances of walking and reduces the need for shunts to treat hydrocephalus. 

“We are one of two major centers in the United States currently to offer this minimally invasive neurosurgical correction,” he says. “Hopefully, in the years to com 

e, we will be able to successfully treat other neurological conditions as well.” 

If needed, this procedure is preferably performed between the 23rd and 26th week of pregnancy. It can be conducted as open surgery under general anesthesia, but our fetal surgeons are equipped to complete it in a much less invasive way. 

As a fetoscopic repair—still performed under general anesthesia—the procedure only requires three small incisions through the mother’s womb instead of a large opening of the womb. The fetoscopic approach decreases mother’s risks compared to the larger cut of the womb. Our surgeons use 2-mm and 3-mm instruments to repair the fetal MMC.  

By bringing together the expertise of neurologists, neurosurgeons, and fetal radiologists, Cincinnati Children’s is standing at the forefront of fetal research, Lim says. 

“We are equipped to lead a multitude of initiatives from both the nonsurgical and neurosurgical perspective,” he says. “We are a comprehensive center that offers currently available interventions, while working on the future of prenatal surgical care, as well.” 

In that vein, our providers are focused on a variety of projects: 

Fetal MRI: Together with colleagues in fetal neuroradiology, Venkatesan is investigating the role fetal magnetic resonance imaging (MRI) can play in more precisely characterizing prenatal brain abnormalities. With a more detailed assessment, neurologists can more accurately predict a child’s long-term outcomes. 

Fetal hydrocephalus: Jose Peiro, MD, PhD, is also working with colleagues to develop a prenatal version of endoscopic third ventriculostomy (ETV). By using endoscopes in fetal lambs, his team has been able to locate and perforate the third ventricle’s tuber cinereum, releasing the trapped cerebrospinal fluid that causes hydrocephalus. 

Prenatal tuberous sclerosis: In collaboration with David Neal Franz, MD, founding director of the Cincinnati Children’s Tuberous Sclerosis Clinic, our providers are investigating new ways to identify at-risk children prenatally. If they are successful, it could change treatment protocols. 

Ultimately, Lim says, these clinical and research collaborations will improve the quality of available fetal neurology and neurosurgery care. 

“By working together, our providers are better prepared to know what to expect and how to medically manage very complicated children,” he says. “As our understanding increases with these collaborations, we will be able to extend the neurology care we offer and develop more appropriate interventions.”