First US brain surgery performed in Boston

The baby shower has been canceled. The all-important car seat was nowhere to be found, pregnant parents Kenyatta and Derek Coleman told STAT. The couple “didn’t know they were going to bring the baby home,” Kenyatta said.

Their daughter had a rare condition called the “Galen’s Veins” malformation. Blood vessels in the fetal brain are not developing properly and connecting incorrectly, which can lead to brain damage, heart failure, or other organ damage.

But the first intrauterine surgery in the United States ensured that the Colemans’ baby could go home. Despite the severity of her condition, her daughter has been doing well since she was born on March 17, two days after surgery by a team from Boston Children’s Hospital and Brigham and Women’s Hospital.

Galenic venous malformation occurs when a fetal brain artery connects directly to a vein, which can be fatal.

STAT reported that a surgical team closely monitored her in the NICU after her birth.

“From that moment on, I really knew this baby was fine,” Darren Orbach, a neuroradiologist at Boston Children’s Hospital, told STAT. “Because all of us caring for these children see how seriously ill these babies are in the NICU for weeks and weeks and months. It was really amazing just to see her looking so good without any drugs or breathing tubes.”

What is a Galenic Vein? Galen vein malformation occurs when the fetal brain is damaged. artery link directly to veinthere are no capillaries in between.

Both arteries and veins move blood, but their roles are very different. Arteries pump oxygenated blood away from the heart at high pressure, and veins return blood at low pressure. Vein walls are thinner due to lower mechanical stress. When fast-flowing blood from arteries is pumped through veins, it becomes a big problem.

“Over time, veins basically expand like balloons,” Orbach told MIT Technology Review.

Because oxygenated blood is diverted before it reaches its destination, the resulting hypoxia can cause brain damage, says Mario Ganau, a consultant neurosurgeon at Oxford University Hospital, Tech Review. told to Infants with Galen’s vein malformation are at risk of cerebral hemorrhage, which puts a sudden new strain on the heart at birth, which can lead to heart failure.

“Suddenly, it puts a lot of strain on a newborn’s heart,” Orbach told Tech Review. “Most babies with this condition quickly become critically ill.”

Severe symptoms develop rapidly after birth, so researchers are trying to treat the condition in utero before the heart and lungs become self-sustaining.

Surgery content: The surgery, published in the American Heart Association journal Stroke, was part of an FDA-approved clinical trial.

Due to the unique nature of the surgery, a team including radiologists, anesthesiologists, and maternal-fetal care specialists was assembled from across Boston Children’s Hospital and Brigham and Women’s Hospital.

A Boston-based team performed the first intrauterine surgery in the United States to treat the malformation.

“In any fetal surgery, there are two patients, the baby and the mother,” said Carol Benson, a radiologist and study co-author at Brigham and Women’s magazine. is an important aspect of . “We have to make sure everything is working together perfectly. Nothing would have been possible without precise communication and teamwork from everyone involved.”

During surgery, injections were given to both the mother and the fetus to prevent pain and keep the fetus motionless during surgery.

Using ultrasound as a guide, the surgeon then inserted a needle through Coleman’s abdomen, uterine wall, and fetal skull into a vein in Galen’s malformation. A small coil of platinum delivered through the needle was then expanded to block the point where the artery and vein are connected. When the blood flow pattern reached a healthy point, the research team stopped administering the coil.

After surgery, doctors and parents were “very pleased to see that he did not exhibit any of the rapid debilitation that is usually seen after birth,” Dr. Orbach said in a statement. Since then, the Coleman daughter has grown “very well.” She does not require medication and has been eating normally since she was discharged from the NICU, gaining weight and living in her own home.

“Elegant and Exciting”: Ibrahim Jarreau, a consultant neurosurgeon at Cambridge University Hospitals NHS Foundation Trust, UK, told Tech Review that the operation was “a very elegant and exciting solution to a difficult problem.”

Jarreau noted that it is only possible to understand the risks of this procedure by studying more cases. Given the rarity of the symptoms, that may take time. But given the poor prognosis for newborns with galenic veins, Jarreau doubts the technology will be a “moving forward.”

The Boston team hopes their fetal surgery technique could represent a “paradigm shift” in treating Galen vein malformation, despite having only one patient so far.

“This may significantly reduce the risk of long-term brain injury, disability, or death in these young children,” Orbach concluded in a statement.

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