First successful intrauterine brain surgery performed | Image credit: © RFBSIP – © RFBSIP – stock.adobe.com.
The first successful intrauterine brain surgery was performed through the treatment of an aggressive vascular malformation known as the vein of Galen’s malformation (VOGM) to repair a fatal developmental condition.
The neonatal arteries, which carry high-flow, high-pressure blood from the heart to the brain, are intended to connect to capillaries that slow blood flow and supply oxygen to the surrounding brain tissue. The arteries are instead connected to the major collecting veins at the base of the brain, putting great pressure on the infant’s heart and lungs during and after birth.
VOGM outcomes include heart failure, pulmonary hypertension, and other life-threatening conditions. Antenatal ultrasound can be used to detect her VOGM, and a magnetic resonance imaging (MRI) diagnosis can be made later in the second or third trimester.
In a recent study at Boston Children’s Hospital and Brigham and Women’s Hospital, researchers performed intrauterine embolization on fetuses at 34 weeks and 2 days of gestation. This process was accomplished by ultrasound-guided transuterine embolization, after which there were no signs of aggressive decline seen in her VOGM patient after birth.
“At 6 weeks, the baby is doing amazingly well, and I am happy to report that he is off medication, eating normally, gaining weight, and is home. Signs of adverse brain effects. No,” said lead study author Darren B. Orbach, MD, PhD.
Delivery by vaginal delivery was performed 2 days after surgery due to premature membrane rupture due to intrauterine embolization. Cardiac output showed progressive normalization during postnatal echocardiography, and no cardiovascular support or surgery was required after intrauterine surgery.
During admission to the neonatal intensive care unit, no stroke, fluid accumulation, or hemorrhage was found in the brain during MRI.
Orbach said this approach could alter the management of VOGM and reduce the risk of long-term brain injury. VOGM is estimated to occur in up to 1 in 60,000 live births and is currently treated by embolization, which closes direct connections between arteries and veins to prevent excessive blood flow.
Embolization is a high-risk procedure and does not reverse heart failure in all cases. Severe brain damage has also already occurred in many cases of embolization, causing long-term cognitive impairment and an increased risk of death. An intrauterine approach may mitigate these adverse outcomes.
“As always, many of these fetal cases must be performed and followed to establish a clear pattern of improvement in neurological and cardiovascular outcomes,” UCLA Mattel Children’s Hospital. “Thus, national clinical trials will be very important to get the right data and hopefully successful results.”
reference
With the first intrauterine brain surgery, doctors eliminated the symptoms of a dangerous condition. newsroom. May 4, 2023. Accessed May 8, 2023. https://newsroom.heart.org/news/in-first-in-utero-brain-surgery-doctors-eliminated-symptoms-of-dangerous-condition