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First Lifesaving In Utero Cerebrovascular Surgery Performed in Boston
A collaborative effort between researchers and clinicians at Brigham and Women’s Hospital and Boston Children's Hospital allowed them to perform the first in utero cerebrovascular brain surgery.
Earlier this month, researchers and clinicians at Brigham and Women’s Hospital (BWH) and Boston Children's Hospital took part in the first in utero cerebrovascular surgery to correct a deadly vascular malformation. This potentially lifesaving milestone was part of an ongoing clinical trial to treat vein of Galen malformation (VOGM).
VGOM is a condition that alters brain connectivity, slowing blood flow and leading to high-pressure flow into the veins. Left untreated, the disease can cause damage to brain tissues and injury, leading to potentially fatal outcomes.
According to the press release from BWH, the case study was published in Stroke on May 4, 2023, detailing the preparation, procedure, and follow-up. The team included radiologists, neuro-interventional radiologists, anesthesiologists, and maternal–fetal medicine physicians, with personnel dedicated to both the mother and the fetus.
“In every fetal surgery, there are two patients: the baby and the mother, and caring for both the fetus and the mother is an important aspect of fetal procedures,” said co-author Carol Benson, MD, staff radiologist at BWH and former co-director of BWH’s High-Risk Obstetrical Ultrasound Service, in the BMH press statement. “You need to make sure that everything is aligned perfectly, and we couldn’t do anything without the precise communication and teamwork of everyone involved.”
Using ultrasound-guided transuterine embolization, the researchers addressed the VOGM in a fetus at 34 weeks and 2 days, seeing a decline in the malformation.
Statements from the health organizations and the clinicians involved revealed that six weeks after birth, the infant treated in this surgery had normal eating patterns and weight gain without additional medications. The family could take home their child with the procedure having no noticeable side effects.
Darren B. Orbach, MD, PhD, Co-Director of the Cerebrovascular Surgery & Interventions Center at Boston Children’s Hospital and an associate professor of radiology at Harvard Medical School, told BMH that “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. This may markedly reduce the risk of long-term brain damage, disability, or death among these infants.”
