Brain surgery performed on a baby in the womb for the first time to prevent heart failure

Fetal surgery has been performed on babies in the womb for several decades, but it is still a relatively rare and complex procedure. The goal of fetal surgery is to treat medical conditions that can cause long-term health problems or even death if left untreated. In recent years, there have been some significant advances in fetal surgery techniques, including the use of minimally invasive procedures that reduce the risks to both the mother and the baby. But for the first time, it was performed to repair a potentially life-threatening developmental condition by treating a dangerous vascular malformation—called the vein of Galen malformation—in a fetus' brain before birth, reported SciTech Daily.

According to Boston Children's Hospital, "A vein of Galen malformation (VOGM) is a type of rare blood vessel abnormality inside the brain. In VOGM, misshapen arteries in the brain connect directly with veins instead of connecting with capillaries, which help slow blood flow. This causes a rush of high-pressure blood into the veins."

Researchers conducted an in-utero embolization on the fetus with VOGM at 34 weeks and 2 days gestational age. They reported, "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."

"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,” said lead study author Darren B. Orbach, M.D., 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.

“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 fetal intervention team at Boston Children’s Hospital and Brigham and Women’s Hospital have successfully devised another in utero procedure that may be very impactful in a specific group of patients diagnosed with the vein of Galen malformation,” said Gary M. Satou, M.D., FAHA, the director of pediatric echocardiography at UCLA Mattel Children’s Hospital and co-director of the UCLA Fetal Cardiology Program. However, he was not involved in the study. “As always, a number of these fetal cases will need to be performed and followed in order to establish a clear pattern of improvement in both neurologic and cardiovascular outcomes,” Satou added. “Thus, the national clinical trial will be crucial in order to achieve adequate data and, hopefully, successful outcomes.”

“However, the positive hemodynamic changes that they observed in utero and after birth – reduction in flow, reduction in the size of the draining vein, reversal of the abnormal reversed flow in the aorta – are really encouraging. These are some of the most exciting and surprising aspects of this case report,” he said. “This is pioneering work being done in a very careful and responsible way.”