Brain surgery performed on baby in womb for first time

‘This may markedly reduce the risk of long-term brain damage, disability or death among infants’

Doctors performed a first-of-its-kind surgical procedure to fix a potentially deadly malformation in the brain of a foetus to avoid injury and heart failure after birth.

The procedure, described recently in the journal Stroke, repaired a potentially deadly developmental condition called Vein of Galen Malformation (VOGM) in the foetus’s brain.

The aggressive blood vessel malformation is a rare condition in which arteries bringing high-pressure blood to the brain from the heart connect directly to veins deep at the base of the brain rather than to the capillaries that slow blood flow and deliver oxygen to surrounding brain tissue.

It is the most common congenital vascular brain malformation occurring in as many as one in every 60,000 births and seriously affecting the heart and brain of newborns after birth, said researchers, including those from Boston Children’s Hospital in the US.

The condition, which can be first seen on an ultrasound, causes enormous pressure on the baby’s life and may lead to heart failure or other potentially life-threatening conditions in the newborn.

A current treatment method involves a catherter-based procedure post birth, called embolisation. In it, the direct artery-to-vein connections in the malformation are closed off to block excess blood flow to the brain and heart.

Scientists, however, said this procedure has high risk and may not always be successful at reversing heart failure.

They said even before the baby is born, severe brain damage may have already occurred, leading to life-long cognitive disabilities and life-threatening conditions for the infant, or even to death.

In the ongoing clinical trial, researchers used ultrasound to address VOGM before birth.

“We were thrilled to see that the aggressive decline usually seen after birth simply did not appear. We are pleased to report that at six weeks, the infant is progressing remarkably well, on no medications, eating normally, gaining weight and is back home. There are no signs of any negative effects on the brain,” study lead study author Darren B Orbach said.

The infant was delivered by induction of vaginal birth two days later when scans showed progressive normalisation of the heart’s output.

Researchers said the newborn was observed in the neonatal ICU for several weeks before being sent home.

During this period, the infant had a normal neurological exam and showed no strokes, fluid buildup or haemorrhage on brain MRI scans.

“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,” Dr Orbach said.

“This may markedly reduce the risk of long-term brain damage, disability or death among these infants,” he said.