Earlier this year, between the 20th and the 24th of May 2017, thanks to our Organization’s support, a team of doctors from Milan’s Policlinic Hospital traveled to Sao Paulo, Brazil. Their mission was to observe a very rare kind of operation being performed at the Albert Einstein Israelite Hospital.

The operation in question is extremely delicate, as it aims to correct a condition called myelomeningocele (a very serious kind of spina bifida). This condition can be detected in uteri even before birth through ultrasounds, and once discovered, an operation is the only option to correct it. Usually, it is necessary to wait for the fetus to be born before the operation can be performed safely; however, Dr. Denise Pedreira, Director of the Albert Einstein Hospital’s Fetal Therapy Center, has developed a technique which allows to correct this condition operating directly on the fetus, using a minimally invasive approach. This technique is the result of over twenty years of research and preparation, and it offers clear advantages for both the mother and the child. This is because, on one hand, it reduces the mother’s risks and the possibility of premature birth. On the other hand, this technique entails a serious improvement on the child’s quality of life. This in terms of motor capabilities, neurological delay and sphincter continence, all of which are potential consequences of this pathology.

The Policlinic’s team of doctors had the opportunity of sitting in on an operation performed using this technique on a patient of Slovakian nationality; the operated fetus was 26 weeks old, and it was affected by myelomeningocele. The woman was brought by her doctors to Sao Paulo, seen as the Albert Einstein Hospital is the only facility in the world which performs this kind of procedure. Other doctors, hailing from London and Cincinnati, also sat in on the operation, as well as Professor S. Rothenberg from Denver, USA. Prof. Rothenberg was recently involved in a collaboration with some of the Policlinic’s surgeons; they all worked on the operation of a child whom we’ll call Tomasino for the purpose of this article. Tomasino had been affected since birth by very serious malformations of both the esophagus and the trachea, and he was hospitalized and operated in Milan’s Policlinic Hospital. Cieli Azzurri was heavily involved in this case, covering most of the hospitalization costs. You can read more about this case in the article " A Life ready to Finally Take Flight"

Following the operation, Dr. Pedreira illustrated the details of her approach to all the visiting doctors, presenting the scientific evidence which supports it. The day after the operation, the visiting doctors had the chance of witnessing its excellent aftermath: the mother and the fetus were doing well, as evaluated on a clinical level and through ultrasounds. Furthermore, all the visiting doctors were invited to sit in on the preliminary discussions around a case of meningocele from Bolivia.

This mission is to be considered as a first step towards one of the main objectives of our “Fetal Surgery” project; that is, to position the Policlinic’s Fetal Center as the go-to Italian facility for myelomeningocele treatment. With this in mind, Dr. Pedreira highlighted what she thought the following steps should be: first, a second mission to Sao Paulo, to sit in on a different operation, preferably with clinical characteristics different from the case discussed in this article. The following step would be for the Policlinic’s doctors to perform an operation using Dr. Pedreira’s technique, under Dr. Pedreira’s staff’s supervision, in Milan.

Cieli Azzurri supported this mission financially as part of our “Fetal Surgery” project. The fact that Italy, at the moment, lacks a facility offering this kind of treatment is source of great motivation for our Organization. Myelomeningocele is, in fact, a very invalidating pathology, and we believe it is important to support the Policlinic’s doctors’ desire of being able to offer the most advanced care to Italian children.