A baby girl was successfully treated with an experimental in-utero surgical treatment for vein of Galen malformation, a life-threatening brain condition. The procedure might save other fetuses with similar conditions.
Doctors have performed an experimental brain surgery on a fetus in the womb, a groundbreaking operation that could be a ray of hope for fetuses with life-threatening brain conditions. A seven-week-old baby girl living near Boston has become one of the first people to have undergone fetal brain surgery while still in the womb. She was diagnosed with vein of Galen malformation, a dangerous condition that could have caused brain damage, heart problems, and breathing difficulties after birth, or worse. Her parents signed up for a clinical trial of an in-utero surgical treatment to intervene before any of these outcomes materialized. The operation was a success, and the baby girl was born healthy a couple of days later, without needing any further treatment for the malformation. This operation is a promising development for fetuses with similar conditions, and it could be a solution to severe brain conditions in the future.
Vein of Galen malformation is a condition that occurs when a vein connects with an artery in the brain. These two types of vessels have different functions and should be kept separate—arteries ferry high-pressure flows of oxygenated blood from the heart, while thin-walled veins carry low-pressure blood back the other way. When the two combine, the high-pressure blood flow from an artery can stretch the thin walls of the vein, causing it to blow up like a balloon. The resulting balloon of blood can cause serious problems for a baby, including brain damage, heart failure, and bleeding in the brain.
Fetuses with vein of Galen malformation are thought to be protected by the placenta to some degree. However, all of a sudden, a massive burden is placed right on the newborn's heart when the umbilical cord is clamped at birth, causing most babies with this condition to become very sick very quickly. To prevent this from happening, several teams are attempting to treat the condition before it can cause severe damage to the fetus. Fetal brain surgery might be the future for conditions like these.
The girl's mother was referred to a clinical trial conducted by Darren Orbach, a radiologist at Boston Children's Hospital, and his colleagues at Brigham and Women's Hospital, also in Boston. On March 15, at 34 weeks of pregnancy, she underwent the experimental operation, which involved a range of medical professionals. The first step was to give the mother a spinal anesthetic to prevent her from feeling anything in the lower half of her body. The mother remained awake for the procedure and was wearing headphones, listening to music.
The second step involved physically moving the fetus around in the uterus to make sure that the brain could be accessed from the front. Before the surgery began, the fetus was given an injection to prevent pain and movement. Doctors then used ultrasound imaging to help them guide a needle through the mother's abdomen, uterus wall, and the fetus's skull and into the malformation in the brain. Members of the team fed a tiny catheter through the needle to deliver a series of tiny platinum coils into the blood-filled pocket. Once each was released, it expanded, helping to block the point where the artery joined the vein.
The team closely monitored blood flow in the fetus's brain as they worked. Once they saw that it had returned to healthy levels, they stopped injecting coils and carefully removed the needle. The baby girl was born healthy a couple of days later and didn't need any treatment for the malformation. She was monitored in hospital for a few weeks and is now home and doing well. The operation was a success, and it shows the potential of fetal brain surgery to treat severe brain conditions before they cause harm to the fetus.
The success of this operation has generated excitement in the medical community. Greg James, a pediatric neurosurgeon at Great Ormond Street Hospital in London, called it a "really exciting breakthrough." Timo Krings, a neuroradiologist at the University of Toronto, said that the operation is "giving a chance to kids who would otherwise have very little possibility of survival." Both experts also acknowledged that fetal brain surgery is not without risks and should be reserved for severe cases where there is a good chance of recovery.
Orbach and his colleagues are not the only ones investigating fetal brain surgery for vein of Galen malformations. Krings is working with Karen Chen at Texas Children's Hospital and her colleagues on a similar trial. Krings has also heard that another baby was born in Paris following a similar procedure. Chen says she knows of another unpublished attempt that took place in Mexico, although that baby sadly died at 10 days old.
Fetal brain surgery might also prove useful in treating other conditions, such as other blood vessel problems or brain tumors, according to Krings. Ganau, a consultant neurosurgeon at Oxford University Hospitals in the UK, agrees, saying that "many conditions that we deal with in the very first weeks of life" could potentially be treated in the uterus.