Summary of Brain Surgery Performed on Baby in the Womb for the First Time:
Researchers have successfully performed the first-ever in-utero surgery to repair a fetus’s life-threatening brain malformation, preventing heart failure and brain injury after birth. Using ultrasound guidance, the researchers successfully restored a potentially deadly vascular malformation, called the vein of Galen malformation, deep in the brain of a fetus before birth. The malformation often leads to heart failure, severe brain injury, or possibly death soon after birth. The first in-utero embolization repair was successfully performed on a fetus at 34 weeks and 2 days gestational age. Since its inception, the infant has required no medication to treat heart failure and no postnatal surgery to treat the malformation. The procedure has the potential to mark a paradigm shift in managing the vein of Galen malformation, where the malformation is repaired before birth to head off the heart failure before it occurs.
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Researchers Perform First-Ever In-Utero Surgery to Repair Deadly Vascular Brain Malformation
In a medical breakthrough, researchers have successfully performed the first-ever in-utero surgery to repair a fetal brain malformation that, left untreated, could lead to heart failure and brain injury after birth. The first-of-its-kind fetal procedure was performed on a fetus experiencing vein of Galen malformation (VOGM), a rare condition where arteries bringing high-flow, high-pressure blood to the brain, connect directly with one of the central collecting veins deep at the base of the brain, rather than to capillaries that are necessary to slow blood flow and deliver oxygen to surrounding brain tissue.
The groundbreaking study, published in the Stroke, used ultrasound guidance to repair the potentially fatal vascular malformation deep in the fetus’s brain before birth. The researchers reported an immediate drop in abnormal blood flow through the malformation after the procedure, and fetal echocardiography showed significant improvement in heart function the day after.
The first in-utero embolization repair was successfully performed on a fetus at 34 weeks and 2 days gestational age. Since birth, the infant has required no medication to treat heart failure and no postnatal surgery to treat the malformation. Repeated echocardiograms after delivery displayed marked improvement in cardiac output, and brain MRIs showed no brain injury and a standard neurological exam.
The study marks a significant shift in how VOGM can be managed. The malformation is traditionally treated after birth with embolization through a catheter to close off the direct artery-to-vein connections in the malformation and block the excess blood flow to the brain and heart. However, embolization is high risk and is not always successful at reversing heart failure. Additionally, severe brain damage may have already occurred, leading to long-term cognitive disabilities and life-threatening conditions for the infant or death.
The fetal intervention team at Boston Children’s Hospital and Brigham and Women’s Hospital have successfully performed another in-utero procedure that may be very impactful in a specific group of patients diagnosed with a vein of Galen malformation.
However, Colin P. Derdeyn, MD, a neuro-interventional radiologist at the University of Iowa Health Care who was not involved with the study, notes that the procedure had limitations. “The key advance here is to intervene before the physiologic events of birth can cause life-threatening heart failure. There are caveats; one successful case is not enough experience for us to conclude that the risks of this procedure are worth the benefits. Safety issues may crop up in future procedures, and this approach through the veins may not be consistently successful in preventing heart failure.”
While the researchers acknowledge the need for more treated patients and continued clinical trials to assess the safety and efficacy, their work marks a significant shift in preventative care for patients with VOGM. “This approach has the potential to mark a paradigm shift in managing vein of Galen malformation where we repair the malformation before birth and head off the heart failure before it occurs, rather than trying to reverse it after birth,” said lead study author Darren B. Orbach, MD, Ph.D., co-director of the Cerebrovascular Surgery & Interventions Center at Boston Children’s Hospital and an associate professor of radiology at Harvard Medical School.
It is estimated that VOGM, the most common congenital vascular brain malformation, occurs in as many as one in every 60,000 births, making the groundbreaking procedure a potential game changer in how patients diagnosed with the condition are managed.
