For the first time, doctors operated on the fetal brain inside the mother’s womb

A child who lives near Boston has made history. This child, who is now seven weeks old, is one of the first people who underwent experimental brain surgery while still in the mother’s womb. This surgery may have saved his life.

Before she was born, this little girl suffered from a dangerous condition that caused blood to pool in a 14 mm pocket in her brain. This condition can lead to brain damage, heart problems and breathing problems after birth and can be fatal.

Her parents enrolled her in a clinical trial of intrauterine surgical treatment to see if doctors could intervene before these consequences occurred. This treatment seems to have been effective.

According to MIT Technology ReviewThe medical team that performed the operation now plans to treat more fetuses in the same way. Other similar brain problems may benefit from the same approach. For problems like this, fetal brain surgery can be a treatment method that is routinely performed in the future.

The baby’s problem, which is called a malformation of the vein of Galen, was first detected during a routine ultrasound during the 30th week of pregnancy. This condition occurs when a vein connects to an artery in the brain. These two types of blood vessels have different functions and should be kept separate.

Arteries carry high-pressure streams of oxygenated blood away from the heart, while thin-walled veins carry low-pressure blood in the opposite direction. When the two combine, high-pressure arterial blood flow can stretch the thin walls of the vein. “Over time, the vein practically pops like a balloon,” says Darren Overbuck, a radiologist at Boston Children’s Hospital in Massachusetts who treats babies with the condition.

The resulting blood balloon can cause serious problems for the child. “This abnormality steals blood from the rest of the circulatory system,” says Mario Ganau, a consultant neurosurgeon at Oxford University Hospitals in the UK, who was not involved in this particular case.

Ultimately, oxygenated blood may not reach other parts of the brain, causing brain damage and the risk of bleeding in the brain, Ganau explains. The extra strain on the heart to pump blood can lead to heart failure. Other organs of the body, especially the lungs and kidneys, may also be damaged.

Fetuses with this condition are thought to be partially protected by the placenta. But this changes from the moment the umbilical cord is closed at birth. “All of a sudden, there’s a huge load on the baby’s heart,” says Overbuck. “Most babies with this condition will get sick very soon.”

Several teams are working to treat the vein of Galen malformation before it becomes a problem, when the fetus is still in the womb. Orbak is a member of one of these teams. He and his colleagues at Boston Children’s Hospital and Brigham and Women’s Hospital have registered a clinical trial in 2020 to test whether fetal brain surgery can help fix this problem.

The mother of the girl under study was referred to the Orbak clinical trial. On March 15, at 34 weeks of pregnancy, she underwent an experimental procedure. The surgery lasted two hours and doctors with different specialties were present.

First, the mother was put under spinal anesthesia so that she would not feel in the lower half of her body. Although he was awake during the procedure, Orbuck said, he was listening to music using headphones.

The second step involved physically moving the fetus in the womb to ensure that there was access to the brain from the anterior part. Before surgery, medicine was injected into the fetus to prevent pain and movement.

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