Doctors performed a groundbreaking brain surgery on a baby before birth, saving her from potential brain injury, heart failure, or death

• Doctors at Boston Children's Hospital performed a first-of-its kind brain surgery on a fetus in utero.
• The novel approach was to treat a child with the rare condition, a vein of Galen malformation.
• The surgery may have saved the patient from heart failure and brain injury. 

Doctors performed a first-of-its-kind brain surgery on a fetus while she was still in the womb, potentially saving the child, Denver Coleman, from heart failure, brain injury, or even death. 

Scientists used a new approach to treat a baby with a vein of Galen malformation (VOGM), a rare blood vessel abnormality in the brain that causes blood pressure to rise in certain veins, leading to heart failure, brain injury, or sometimes death. 

Instead of treating the baby after birth, Dr. Darren Orbach, chief of Neurointerventional Radiology at Boston Children's Hospital, used a new procedure to insert a needle into the fetus and inject a tiny metal coil to slow blood flow into the compromised vein — all while Coleman's mother was still carrying her.

Coleman received the operation in utero at 34 weeks of gestation, and she was delivered two days later on March 17. Doctors did not identify any brain or heart issues after birth, according to the research letter on the surgery published in the journal Stroke, and Coleman's parents told CNN that their baby remains healthy.

"Just to see her look fine, really on no medication and not in a breathing tube or anything like that, that was really fantastic," Orbach told STAT News. 

A new approach for high-risk VOGM patients

A VOGM abnormality forms during the first trimester of the fetus' development. Typically, doctors treat infants with VOGM after delivery, according to Boston Children's Hospital, by injecting a tool that restricts blood flow in the vessels of the abnormal vein to keep blood pressure from rising.

But the deadly side effects of VOGM can occur immediately after delivery, before doctors have a chance to operate on the baby. Orbach hypothesized that operating while the fetus is still in utero could reduce the risk for death and brain injury. 

In 2020, Orbach and Boston Children's Hospital launched a clinical trial to design the new, in-utero approach. But finding the right candidate took time, Orbach told STAT, as the condition is so rare, and the surgery required a candidate who was healthy enough for an in-utero operation, but still at a high risk for complications from VOGM.

Coleman is the first of 20 patients in the clinical trial who are slated to receive the new procedure, Orbach told STAT, as doctors still need more data and practice to determine the best way to perform the surgery. 

Coleman has remained a healthy baby more than two months after birth, requiring no medication and presenting normal on neurological exams.