SURGEONS in the United States have used a “surgical superglue” to seal a ruptured aneurysm in a newborn baby’s brain, saving her life in a procedure hailed as a medical first.
Ashlyn Julian has been making “steady strides” since she underwent the procedure at 20 days old and is expected to live a normal, healthy life, said her surgeon at the University of Kansas Hospital.
Dr Koji Ebersole and his team moved in after a scan showed an almond-sized bulge in a blood vessel deep inside the baby’s brain, which had bled twice and threatened to kill her.
So rare is the condition in a baby so young, with only 17 cases recorded since 1949, that no surgical instruments have ever been made that are small enough to deal with it.
“We did not know what the right answer was. This was not a textbook case. If you try to treat the baby without closing the aneurysm … most of those babies can’t survive. So we had a strong reason to develop a plan to close the aneurysm,” said Dr Ebersole.
Describing Ashlyn’s brain prior to the procedure as “eminently angry”, he recalled how he and his team realised that they had no choice but to improvise a solution.
“If we don’t do something, this aneurysm is going to take her life – so you’re willing to take on a fair amount of risk,” he said.
Dr Alan Reeves, an interventional radiologist, inserted a micro-catheter the width of a pencil into a blood vessel in the baby’s groin, then inched it through her body and into her brain using a guide wire that measured less than the width of a human hair.
Once the catheter was in position alongside the aneurysm, Dr Ebersole squeezed a drop of glue through the catheter and onto the ruptured vessel to seal it.
Known by its brand name of Trufill, the substance has been used more than 15,000 times since 2000 in adults, but never before in a neo-natal patient with a brain aneurysm because a newborn’s blood vessels are minuscule, making access deeply challenging. It is formulated from the same chemical compound as household Superglue.
In adult patients, surgeons would also have the option to operate on the aneurysm by opening the skull to get to the brain. In a baby Ashlyn’s size, however, no tools are small enough – and the aneurysm was located deep in the brain. Heavy blood loss would have been an additional complication.
“The difficulty is, on a child so small, any amount of blood loss represents a significant percentage of her overall blood volume. So a surgery on the brain to approach something that wants to bleed – we could have been in a situation with bleeding we could not keep up with, and that would have been life-threatening,” Dr Ebersole explained.
Ashlyn is recovering well in hospital and is expected to be discharged within weeks. Her surgeon believes that she has suffered no lasting effects from her drama.