Ultrasound of a Vein of Galen Malformation. (Image courtesy of the American Heart Association)
Imagine you’re parched, reaching for a glass of water, but instead of sipping gently from a cup, you’re suddenly drinking from a fully open garden hose. It’s overwhelming, uncontrollable, and not the soothing relief you expected. Now, imagine that happening in your brain—that’s what a baby with a vein of Galen malformation (VOGM) faces. Their brain receives a gushing torrent of blood, rather than the delicate trickle it requires.
To understand VOGM, we first need to understand our primary blood vessels: veins, arteries, and capillaries. Arteries are vessels that deliver oxygen-rich blood from the heart to the body under high pressure. Meanwhile, veins transport deoxygenated blood back to the heart, working under lower pressure. Capillaries are much smaller than arteries and veins and connect the two, facilitating the exchange of gases and nutrients. In VOGM, arteries in the brain bypass the capillaries, forming direct links to the vein of Galen. This abnormal connection thrusts high-pressure blood into a vein designed for low pressure. The resulting strain swells the vein, just like an overblown balloon—leaving it at risk for rupture. Furthermore, bypassing capillaries deprives some brain tissue of essential blood. To address this, the heart pumps more blood into the brain, overloading it and causing multiple other complications such as heart failure and hydrocephalus, the buildup of fluids in cavities within the brain.
Addressing VOGM early is crucial to prevent these complications. However, previous treatments could only be conducted after the baby was born, when significant damage had already been caused. That’s where Dr. Darren Orbach came in; as the Chief of Neurointerventional Radiology at Boston Children’s Hospital (BCH), he envisioned a different approach for VOGM. Instead of waiting until the baby was born, could they intervene and treat the malformation while it was still in the womb? Through meticulous collaboration with fetal medicine specialists and the Brigham Women’s Hospital, the idea began to take shape.
The primary challenge was navigating the delicate fetal brain, all while ensuring safety for both mother and unborn child. Their final procedure utilized a microwire, consisting of tiny metal coils. Through skilled precision and real-time ultrasound imaging, they placed the coils on the abnormal arteries, limiting blood flow back to a normal amount.
This innovative in-utero procedure marked a turning point for VOGM treatment. By intervening before birth, the team at BCH has given hope to countless babies and their families. Now, the doors open to all the other procedures that could occur before a child even takes its first breath outside the womb. This approach doesn't just offer a solution to VOGM; it challenges the traditional boundaries of medical intervention. It raises questions and possibilities about how early we can intervene, how much we can correct, and how innovative we can be in ensuring the best start in life for those who need it most.
Written by Meghna Singh