To the fetus that is still in the womb of a pregnant woman,
Do a surgical operation,
What is the concept?
A needle is threaded through
Mother's womb and fetal head floating in amniotic fluid,
Every slightest movement in the surgeon's hands,
All affect the fate of two people......
On January 19, 2024, Ms. Lin (pseudonym), a pregnant woman, lies on the operating table. Under the shadowless lamp, everyone was on standby.
The target of the operation was the baby in Ms. Lin's womb, a fetus that did not even have a nickname, but had suffered from intracranial diseases. TA is diagnosed with severe hydrocephalus.
Fortunately, the surgery was successfully completed.
After more than two months of waiting, the results of the examination are improving. On March 22, the child was born at term, and the brain development was normal, and the family's hanging heart was finally put down, and Ms. Lin cried with joy!
According to the new investigation, this 7.5-pound healthy baby is the first child in China to be cured of fetal hydrocephalus through intrauterine surgery and successfully born at term.
01
Hard-won children
Diagnosed with intracranial disease before birth
"It's really not easy...... Ms. Lin recalled the experience along the way, her eyes blurred with tears.
"I had two miscarriages in my first two births, and I finally conceived my third child, and the examination before 22 weeks of pregnancy was fine, but I did B ultrasound at 29 weeks and found that the ventricles were widened......"
Ms. Lin checked the Internet and found that many fetal babies with hydrocephalus were eventually induced. Thinking that she had already had fetal movements, and caressed the child who had not yet had time to meet through her belly, Ms. Lin burst into tears.
At the beginning of 2024, Ms. Lin, who was 29 weeks pregnant, came to Northwest Women and Children's Hospital for a follow-up MRI of the fetal head and was diagnosed with severe hydrocephalus.
02
"I want this kid so much"
The doctor decided to operate on the fetus through the belly
Director of the Department of Neurosurgery of Northwest Women and Children's Hospital judged that fetal hydrocephalus is progressively aggravating and continues to develop, which will cause brain tissue dysplasia and leave serious sequelae. However, if the child is born prematurely and then undergoes surgery, the child will be too careful and the lung function will not mature, and there will be a great risk. Combined with Ms. Lin's examination, there is no obvious malformation of the fetal brain structure at present, and if the hydrocephalus is intervened in time, the child has a chance to return to normal.
Ms. Lin said firmly: "I want this child so much, as long as there is a little hope, I also want to give my child a chance to live." ”
03
A needle is threaded through
The abdomen, uterine wall, and the skull of the fetus
The Fetal Medicine Center of Northwest Women and Children's Hospital quickly organized multidisciplinary discussions and developed an individualized intrauterine surgery plan.
On January 19, 2024, with the close cooperation of the Department of Obstetrics, the Ultrasound Center, the Department of Anesthesiology, the Medical Genetics Center and other departments, Director Fang Bo of the Department of Neurosurgery successfully completed the external drainage of fetal ventricular puncture under the guidance of B-ultrasound.
During surgery
Pale yellow cerebrospinal fluid (CSF) was drained during the operation (suggesting that the fetus had had intraventricular hemorrhage), and the ventricles were significantly reduced during the operation, relieving the symptoms of high intracranial pressure. At the same time, amniocentesis was completed to further detect the gene chromosomes.
After the operation, Ms. Lin suppressed the contractions in our hospital and was discharged smoothly. Periodic follow-up tests show that the fetal ventricles gradually return to normal and the gene chromosomes are normal.
04
The first fetus with severe hydrocephalus in China
Intrauterine surgery cured full-term spontaneous birth
After 39 weeks of pregnancy, Ms. Lin came to Northwest Women and Children's Hospital again and successfully gave birth to a 7.5-pound healthy female treasure.
On the second day of birth, the neonatal skull MRI showed that the child's brain tissue structure and ventricular size had returned to normal. The child's growth indicators were normal.
According to the new investigation, this 7.5-pound healthy baby is the first child in China to be cured of fetal hydrocephalus through intrauterine surgery and successfully born at term.
Director of Neurosurgery Fang Bo introduced:
Fetal ventricular widening is a common outpatient consultation question, and the degree of ventricular widening that can be diagnosed as hydrocephalus is usually judged by the width of the ventricles under ultrasound. Generally, the width of the posterior ventricular angle is less than 10 mm, and more than 10 mm requires further MRI examination to determine the brain structure.
The fetus is not a miniature version of an adult, and the brain development of the fetus at different stages has different morphologies, which requires the judgment of a professional neurosurgeon, and intrauterine surgery of the fetus also has strict surgical indications.
At present, our hospital has successfully cured severe hydrocephalus through intrauterine surgical intervention, providing successful experience and confidence for the treatment of hydrocephalus in China, and will help more families in the future.
01
What is hydrocephalus in the fetus
It is a pathological condition in which the cerebrospinal fluid in the fetal ventricles collects excessively during fetal development, resulting in ventricular dilation and increased intracranial pressure.
Cerebrospinal fluid (CSF) is a colorless, transparent fluid that surrounds the brain and spinal cord and fills the ventricles and cisterns.
02
What causes hydrocephalus in the fetus
Fetal hydrocephalus is partly related to gene chromosomes, and X-linked midbrain aqueductal atresia syndrome is a genetic abnormality caused by maldevelopment of the aqueduct in the midbrain. This hydrocephalus may occur in the first trimester, and ultrasonography will reveal abnormal dilation of the lateral ventricles.
The common cause of hydrocephalus in the second and third trimesters of pregnancy is intraventricular hemorrhage, and the subependymal cyst indicated by B-ultrasound is a small hemorrhage, and if the hemorrhage breaks into the ventricles, it will cause cerebrospinal fluid absorption and circulation disorders, and then cause hydrocephalus.
03
When can intrauterine surgery be done?
Between 24 and 32 weeks of pregnancy, for progressive hydrocephalus, intrauterine surgical intervention can only be considered after the genetic chromosomal problem is investigated, and the brain tissue is not significantly damaged, and intrauterine infection, severe malformation and other problems are ruled out.
Surgery can improve the characteristics of cerebrospinal fluid, create a normal intracranial pressure environment for the development of brain tissue, and the fetus has a strong potential for development and repair, and timely treatment can minimize sequelae and improve prognosis.
04
What are the surgical options for hydrocephalus in the fetus?
Repeated fetal ventricular puncture external drainage, fetal ventricular puncture catheter ventriculo-amniotic shunt, fetal triple ventriculostomy, fetal lateral ventricular choroid plexus cautery, etc., some techniques are still being explored and studied.
In short, if you find neurological problems during pregnancy, please see a doctor in time, with the update and progress of technology and treatment concepts, a considerable number of diseases can be operated on in utero, and good treatment results can be achieved.
According to Northwest Women's and Children's Hospital O10