Surgeons have successfully performed the first brain surgery on a fetus still in the womb, repairing a potentially deadly vascular malformation from deep within the developing brain. Using ultrasound to guide the surgeons, the fetus was operated on at just 34 weeks and two days gestational age, marking a huge leap forward in the treatment of developmental disorders.
The fetus was diagnosed with a vein of Galen malformation, an often deadly and aggressive formation that involves arteries within the brain connecting directly to veins instead of first passing through capillaries. Capillaries are specifically designed to slow down blood pressure, so the malformation results in extremely high blood pressure as it rushes straight into the veins. This places the brain and heart under enormous strain during and after birth and can lead to pulmonary hypertension, heart failure, and other life-threatening conditions.
It is diagnosed during pregnancy and typically treated by a minimally invasive procedure called endovascular embolization, in which a surgeon enters through the groin and uses a tube to enter the brain vasculature, injecting glue to cut blood supply.
The surgeons performed a similar surgery, but this time it was entirely in-utero. Under supervision of the US Food and Drug Administration, they managed to block high-pressure blood vessels in the brain of the fetus, preventing the surge of pressure during birth.
Following the surgery, the child was born and appears to have no ongoing problems.
“In our ongoing clinical trial, we are using ultrasound-guided transuterine embolization to address the vein of Galen malformation before birth, and in our first treated case, we were thrilled to see that the aggressive decline usually seen after birth simply did not appear,” said lead study author Darren B. Orbach, co-director of the Cerebrovascular Surgery & Interventions Center at Boston Children’s Hospital, in a statement.
“We are pleased to report that at six weeks, the infant is progressing remarkably well, on no medications, eating normally, gaining weight and is back home. There are no signs of any negative effects on the brain.”
Despite being watched closely following birth, the child did not need any cardiovascular support and all neurological scans were normal. There will now hopefully be more children that will undergo this procedure when possible, in the hopes of improving their outlook and continuing to improve the safety of the surgery.
“While this is only our first treated patient and it is vital that we continue the trial to assess the safety and efficacy in other patients, this approach has the potential to mark a paradigm shift in managing vein of Galen malformation where we repair the malformation prior to birth and head off the heart failure before it occurs, rather than trying to reverse it after birth,” Orbach said.
“This may markedly reduce the risk of long-term brain damage, disability or death among these infants.”
The research is published in Stroke.