Boston Children’s Hospital Performs First-Ever Fetal Brain Surgery to Treat Rare Blood Vessel Abnormality
Doctors at Boston Children's Hospital have performed the first-ever fetal brain surgery to treat a rare blood vessel abnormality that can be fatal to newborns. Using a surgical technique called embolization, the procedure was guided by ultrasound, which allowed surgeons to successfully treat a prenatal condition called vein of Galen malformation. This vascular abnormality allows blood to flow dangerously fast through part of the brain after a child is born, potentially leading to heart failure, severe brain injury, or death. A new ray of hope has emerged in the treatment of the condition, as the procedure has proven to be successful in addressing it before the risk of complications becomes more severe. The newborn, who did not require any cardiovascular support or surgery following the in-utero treatment, was watched in the NICU for several weeks before being sent home. At six weeks, the infant was progressing remarkably well, with no medications, normal eating habits, and weight gain, and there were no signs of any negative effects on the brain.
The malformation is a rare prenatal condition in which arteries bringing high-flow, high-pressure blood to the brain from the heart connect directly with one of the main collecting veins deep at the base of the brain, rather than to capillaries that are necessary to slow blood flow and deliver oxygen to surrounding brain tissue. As a result of alterations in the infant's vascular physiology throughout and following the delivery, the malformation's high flow exerts a more severe impact on the heart and brain following birth, placing significant strain on the newborn's lungs and heart. The possible consequences include the development of pulmonary hypertension, heart failure, or other conditions that could potentially threaten one's life. The appearance of VOGM is typically initially detected through a prenatal ultrasound, but its definitive diagnosis is confirmed through the use of MRI during either the later stages of the second trimester or the third trimester of pregnancy.
The procedure involved repairing the potentially deadly vascular malformation deep in the brain of the fetus before birth. This was achieved using a new approach that had never been used before. A new ray of hope has emerged in the treatment of the condition, as the procedure has proven to be successful in addressing it before the risk of complications becomes more severe. However, one successful case is not enough experience for medical professionals to conclude that the risks of this procedure are worth the benefits. There is a potential for safety concerns to arise in upcoming procedures and the use of the venous approach may not always effectively prevent heart failure. The procedure described here is designed to reduce the flow through the malformation and not to cure it.
As many as one in every 60,000 births may experience VOGM, which is the most prevalent congenital vascular brain malformation. Current standard treatments are performed after birth, but this new procedure shows promise for repairing the malformation prior to birth, heading off heart failure before it occurs, rather than trying to reverse it after birth. This approach offers a potential paradigm shift in managing vein of Galen malformation, and researchers will continue to perform and follow fetal cases to establish a clear pattern of improvement in both neurological and cardiovascular outcomes. A national clinical trial will be crucial in order to achieve adequate data and, hopefully, successful outcomes.
0. “Doctors Conduct Brain Surgery on Fetus in Womb in World First” ScienceAlert, 5 May. 2023, https://www.sciencealert.com/doctors-conduct-brain-surgery-on-fetus-in-womb-in-world-first
1. “Boston doctors perform surgery on baby's brain while still in the womb: Infant ‘progressing remarkably well'” Fox News, 4 May. 2023, https://www.foxnews.com/lifestyle/boston-doctors-perform-surgery-babys-brain-while-still-womb-infant-progressing-well
2. “Boston Doctors Perform ‘First-of-Its-Kind' Brain Surgery on Baby in Womb” Yahoo Entertainment, 5 May. 2023, https://www.yahoo.com/entertainment/boston-doctors-perform-first-kind-035748907.html
3. “Baby successfully undergoes brain surgery — while still inside the womb!” Study Finds, 4 May. 2023, https://studyfinds.org/baby-brain-surgery-inside-the-womb
4. “Brain surgery carried out on fetus for first time” The Daily Collegian Online, 5 May. 2023, https://www.collegian.psu.edu/partners/life/brain-surgery-carried-out-on-fetus-for-first-time/article_64d43e45-4071-5364-832f-d543c6e1376e.html
5. “Doctors do first-ever brain surgery on unborn baby” WWL, 6 May. 2023, https://www.audacy.com/wwl/news/national/doctors-do-first-ever-brain-surgery-on-unborn-baby