Yves Ville, head of the obstetrics department at the Necker hospital, participated in the in utero operation of a baby suffering from a serious malformation. He tells franceinfo, this Friday, the success of this world premiere.
It is a child, born on October 16, 2022, suffering from an aneurysmal malformation of the vein of Galen, that the head of the obstetrics department at the Necker hospital operated on in utero, five weeks before his birth. “It’s a hope that did not exist until then for these serious forms” malformation said Yves Ville.
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Franceinfo: How did this operation go?
Yves Ville: It’s the first. Usually, it is an operation that is done after birth, but the children who benefit from it are often in very poor condition; especially their brain and heart function. We performed this operation in utero, we had a direct approach [une voie d’abord est une voie d’accès chirurgical à un organe ou à une région anatomique donnée] of this vascular malformation which deprives the brain of blood and therefore of oxygen and which causes a cardiac overload, often unbearable by the fetus or the newborn. We significantly reduced the size of this vascular malformation and this little one was stabilized and was able to wait five weeks in its mother’s womb to be born at term. Today, at 8 months, he is cured.
What moment was tricky?
The technique was not complicated, but this tumor is buried right in the middle of the brain so what was tricky was to calculate the length of the platinum filaments that would have to be inserted into this tumor to slow it down without obstructing it. For this, we had a collaboration with Harvard which was thinking about the same problem.
What prompted you to attempt this operation?
For years, this malformation has been well known, but rare since it affects one in 50,000 pregnancies. When this malformation gets carried away, we can’t do anything. Until then, there was nothing that could be attempted. We had the fear that a direct access by a needle in utero would cause a massive cerebral hemorrhage. But by thinking about the equipment and the technique, I think we have found a way that allows us to do it in good conditions and that offers hope that did not exist until then for these serious forms.
What did the parents say about the risk?
The risk of the malformation was to die or to have very serious sequelae in 90% of cases. As for the risks of the intervention, we could explain them, in particular that of the haemorrhage of this tumour. Given the risks of doing nothing, the family made this courageous decision.
This opens up an approach to these vascular malformations which until now was impossible. It’s a message of hope for situations that frustrate us and have been the drama of parents for years.