In a First, Surgeons Repair Malformation in the Brain of the Foetus

In a first of its kind, surgeons successfully repaired a major malformation in the brain of a foetus. The surgeons from Boston Children’s Hospital and Brigham and Women’s Hospital in the US used a surgical technique called embolization to treat a rare prenatal condition. Called vein of Galen Malformation, the vascular abnormality permits blood to flow dangerously fast through part of the brain after the child is born.

Darren Orbach, neurointerventional radiologist from Boston Children’s Hospital and Harvard Medical School, said that they used ultrasound-guided transuterine embolization to address the vein of Galen malformation before birth. He said that the infant was 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, he added.

VEIN OF GALEN

Vein of Galen malformation affects only one in 60,000 infants. It is a rare type of vascular abnormality in the brain that causes arteries to connect directly with the veins rather than the capillaries. This means that the flow of blood into the veins is much higher than is safe, with a number of deleterious effects. The condition places significant stress on the cardiovascular system, which can lead to heart failure. It can cause hypertension in the arteries in the lungs and heart. And because of the additional pressure in the brain, it can cause significant brain damage that results in neurological and cognitive impairment. It also has a high mortality rate.

It’s usually treated after birth with embolization. This is a technique in which surgeons place specialised material in the vein to block it, such as a clotting agent. This clotting agent helps the blood to coagulate and thus prevent the blood from flowing.

But the condition can rapidly change for the worse after birth. The low resistance of the placenta helps regulate blood flow and blood pressure, giving the foetus some protection that it loses when it is born. Soon after birth, a small blood vessel that connects a lung artery to the aorta closes, which also adds to the pressure in the arteries of the lungs.

THE SURGERY

The patient was a foetus at 34 weeks and 2 days gestation (full term is around 40 weeks). The surgeons used ultrasound to guide them as they performed the embolization procedure.
The infant was subsequently induced two days later, since the procedure had resulted in the premature rupture of membranes in the uterus. However, once the baby was born, its cardiovascular system seemed to be working normally, and it required no additional support or surgery. They saw no signs at all of neurological malfunction, fluid build-up or bleeding, and mother and babe were given the all-clear and sent home.
The team’s results have been published in Stroke.

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