MONDAY, May 8, 2023 (HealthDay News) -- Transuterine ultrasound-guided fetal embolization of vein of Galen malformation is feasible and eliminates postnatal pathophysiology, according to a research letter published online May 4 in Stroke.
Darren B. Orbach, M.D., Ph.D., from Boston Children's Hospital, and colleagues presented the first case of in utero embolization of a fetus diagnosed with vein of Galen malformation. The fetus was 34 2/7 weeks of gestational age at intervention, which involved ultrasound-guided percutaneous transuterine, transcranial embolization.
The researchers found immediate marked flow reduction in the varix and falcine sinus on intraprocedural ultrasound. A 43 percent reduction in total cardiac output was seen on fetal echocardiography after embolization. On fetal magnetic resonance imaging, diminution in caliber of the prosencephalic varix and width of the falcine sinus was seen (12.9 to 8 mm); there was no evidence of subdural, subarachnoid, or intraventricular hemorrhage or infarction. The infant was delivered by induction of vaginal birth at 34 4/7 gestational weeks due to premature rupture of membranes, with a birth weight of 1.9 kg. No cardiovascular support and no postnatal embolization were required by the 3-week-old infant. The infant had a normal neurological examination. On postnatal days 1 and 7, magnetic resonance imaging demonstrated further decrement in varix and falcine sinus caliber.
"This approach represents a paradigm shift in management of this challenging condition, from a strategy focused on reversing severe multiorgan pathophysiology after onset, to one focused instead on prevention via embolization in utero," the authors write.
One author is a consultant for Microbot Medical.