Doctors Perform World’s First Brain Surgery on a Fetus in the Womb : ScienceAlert

For the first time, surgeons have successfully repaired a major fetal brain malformation.

Guided by ultrasound, the surgeon Boston Children’s Hospital and Brigham and Women’s Hospital, USA A surgical technique called embolization was used to treat a rare prenatal condition. A blood vessel abnormality called a Galen’s vein causes blood to flow dangerously fast through parts of the brain after a child is born. Successful surgery offers new hope for treating the condition before the risk of complications increases.

Although this is only the first patient treated in this manner, the procedure seems to have been a resounding victory.

“Ongoing clinical trials are using ultrasound-guided transuterine embolization to address Galen malformation veins prenatally. I was thrilled that the decline simply didn’t show up, says Darren Orbach, a neuro-interventional radiologist at Boston Children’s Hospital and Harvard Medical School.

“At 6 weeks old, baby is drug-free, eating normally, gaining weight, coming home and I am happy to report that he is doing amazingly well. Signs of adverse brain effects. there is no.”

Galen Venous Malformation, which affects approximately 1 in 60,000 infants, is a rare type of vascular anomaly in the brain in which arteries connect directly with veins rather than the capillaries that control blood flow. This means that the blood flow to your veins is much higher than safe and has many detrimental effects.

This condition puts great stress on the cardiovascular system and can lead to heart failure. It can cause high blood pressure in the lungs and heart arteries. It also puts additional pressure on the brain, which can cause significant brain damage and lead to neurological and cognitive impairment.

This is usually treated with embolization after birth. In this technique, a surgeon places special substances, such as clotting agents, into veins to help blood clot and block blood flow.

However, after giving birth, the condition can deteriorate rapidly. The low resistance of the placenta helps regulate blood flow and blood pressure, giving the fetus the protection it loses when it is born. increase.

A scan of an infant’s brain. From the left, before embolization, immediately after birth, and immediately after birth. (Obach et al., stroke2023)

Therefore, Orbach and his colleagues are conducting clinical trials to evaluate the possibility of treating the condition prenatally. Their patient, who was 34 weeks pregnant and he was a 2-day fetus (term term approximately 40 weeks), was undergoing embolization using ultrasound.

This procedure resulted in premature endometrium rupture and the infant was subsequently induced 2 days later. However, when the baby was born, its cardiovascular system appeared to be functioning normally and no additional support or surgery was required. All the while, doctors continued to monitor the baby’s brain.

They saw no signs of neurological dysfunction, fluid accumulation, or bleeding. The mother and baby were cleared and sent home.

As this is the first patient in an ongoing clinical trial, the technology is not ready for widespread application. One success story is not enough to establish a pattern of success. Future cases may not proceed smoothly. Whether the benefits outweigh the risks of the procedure remains to be determined.

“As always, many of these fetal cases need to be performed and followed to establish a clear pattern of improvement in neurological and cardiovascular outcomes. Nationwide clinical trials will be critical to obtaining good data and hopefully successful results.”

However, the results are very promising. At the time of this writing, the infant continues to grow, suggesting that prenatal surgery may become a lifeline, at least for some patients.

“While this is our first treatment patient and it is important that we continue the trial to assess safety and efficacy in other patients, this approach is the first of its kind in Galen malformation, which pre-repairs the malformation. It may represent a paradigm shift in venous management: rather than trying to reverse heart failure after birth, it’s about giving birth and avoiding heart failure before it develops,” Orbach said.

“This could significantly reduce the risk of long-term brain injury, disability, or death in these infants.”

Team results published stroke.

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