Brain surgery has been successfully carried out on a baby in the womb for the first time, with the procedure detailed in a recently published study in the peer-reviewed journal, Stroke.
The incredible landmark surgery was performed in the U.S. while the baby’s mother was 34 weeks pregnant, with the baby born on 15 March. The study outlined the process which was undertaken by doctors to repair a malformed blood vessel in the unborn baby’s brain.
The baby girl named Denver did not require any medications or treatments since she was discharged from hospital, according to the study.
Denver’s mother Kenyatta has since opened up about the remarkable surgery – saying that her little girl has been doing “fantastically well” since the 20-minute pioneering operation.
Kenyatta Coleman, 36, said it was “the most beautiful moment being able to hold her, gaze up on her and then hear her cry” – after the potentially fatal condition was discovered during a 30-week-scan. Last month, her mother shared their story on NBC’s Today Show, describing the procedure and its outcome as a “miracle”:
The process, described by medics as a “first-of-its-kind procedure” was carried out as part of a trial, conducted in order to find a new treatment for Vein of Galen malformation (VOGM), rare blood malformations in the brain which develop before birth and may be discovered during pregnancy or very soon after birth.
Great Ormond Street details how the rare neurological condition can cause pressure on the brain, an enlarged head (hydrocephalus), and prominent veins on the face and dark circles under the eyes. The heart may also be affected by the increased workload and become enlarged. If untreated, VOGM may lead to heart failure.
The most common treatment for a child with VOGM is endovascular embolization, which is a minimally invasive procedure and sees the neurovision insert a catheter through an artery in the child’s groin through a tiny incision, and up into the brain. A special material is then injected into the blood vessels of the VOGM to close off the blood flow.
Research carried out on the rare condition has shown that during the first month of a child’s life, roughly a third of patients with the condition do not survive – and a similar proportion will experience moderate to severe neurocognitive compromise, even when treatment is carried out. Only one third of children with the condition will make it into adulthood without significant issues.
The breakthrough surgery was carried out in Boston, with doctors using an ultrasound to help guide a needle into the mother’s abdomen, up through the uterus wall, and into the baby’s brain.
Authors of the study, published in May, explain how, despite decades of technique refinement of transarterial embolization and the establishment of specialty referral centres for the rate condition, unborn children diagnosed with vein of Galen malformation continue to have high mortality, with survivors facing high rates of severe neurological and cognitive morbidity.
Authors point out that the process of birth changes how blood flows in the unborn child, with greater risks that the connection between the artery and vein could lead to multiple other problems for the baby – such as heart failure, effects on the brain and blood clots.
In utero, the foetus is protected by low resistance placental circulation, meaning the risk of complications is lower.
Authors detailed how the procedure was successful, with “immediate marked flow reduction” seen on the ultrasound intraprocedural – and a 43% fall in total cardiac output after echocardiography.
The authors detailed how baby Denver was delivered by induction at 34 weeks, and at three-weeks old, had required no cardiovascular support and no postnatal embolization – with the baby’s neurological exam being normal.
They reported that the expected aggressive postnatal natural history for the child had been completely eliminated – saying that the surgery represented a “paradigm shift in management” of the challenging condition, from a strategy focused on reversing the condition after onset, to “one focused instead on prevention via embolization in utero.”
Two days following the operation, baby Denver made her entrance into the world, which was a time of “relief and joy” for her parents. She has continued to defy all odds since the operation, according to her mother. Denver was brought home three weeks later to meet her three older siblings.
“I remember crying out to God the night before [the surgery] to give us the strength we needed to get through the unknown,” Denver’s mother Kenyatta told NBC. “We were believing in God for a miracle.”
Kenyatta and her husband Derek say making history through the surgery is not just about Denver.
“We want to allow the opportunity for other parents to turn to the same procedure in hopes of saving their children,” Kenyatta said, adding she considered “every child that lost a battle” over the condition.
They say they want Denver to grow up to understand how “impactful” the entire journey has been – adding that they hope her story will “change the world” for other families too.
“She’s doing amazing,” her mother said. “There have been more improvements since she’s been discharged.”