Boston Children’s Hospital was the site of the first fetal surgery for blood vessels in the brain
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For the first time, surgery has corrected abnormal blood vessels in the fetal brain. The baby has a rare condition called galenic venous malformation and was born without complications.This indicates that the procedure can safely treat infants
A Galen vein malformation forms before birth when an artery in the brain connects to a central vein in an organ. This causes this vein to dilate, allowing more blood to flow in, putting pressure on the heart and lungs and depriving the brain of oxygen. develop symptoms.
Darren Orbach of Boston Children’s Hospital in Massachusetts said: Before an infant with this condition is born, the placenta helps relieve some of the pressure. “Despite our best efforts, they unfortunately either died or remain severely brain-damaged,” he says.
Orbach and his colleagues performed surgery to correct fetal malformations at 34 weeks and 2 days of gestation. An MRI scan revealed a central vein greater than 14 mm in diameter. “If the vein width is 8 mm or more of his, there is a 90% chance that the baby will be seriously ill after birth,” Orbach says. “This is one of the most aggressive deformities he’s ever seen.”
Women carrying fetuses underwent spinal anesthesia prior to surgery, and fetuses were also injected with anesthetic to prevent movement during surgery. A needle was then inserted into the uterus. An ultrasound image helped point it to the back of the fetus’ head where the malformation was.
The surgeon gently pushed the tip of the needle into the vein. A catheter placed through the needle was then used to insert a special metal coil into the extra space created by the deformity. These coils reduce the amount of blood flowing through your veins. Surgery time is less than 2 hours.
An ultrasound the next day showed a 43% reduction in the amount of blood being pumped out of the fetal heart. His MRI taken before and after surgery also revealed that the vein had shrunk by about 5 mm in diameter. The baby was born prematurely 2 days later with no complications. She did not need heart medications or additional surgery.
“It’s remarkable because these babies are usually very seriously ill,” Orbach says.
The surgery is a promising approach to prevent brain damage and death in infants with Galen venous malformations that cannot be treated after birth, says Courtney Wasthoff of Stanford University in California. “The downside is that whenever you’re doing fetal procedures, you’re at risk of complications, especially premature birth,” she says.
“It’s very exciting to have these results in the first patient, but it’s literally the first patient. We need to do the science and demonstrate that it works across patients.” , says Orbach, who plans to perform surgery on an additional 19 participants.
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