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                        JeffNEWS, January 10, 1995
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Neurosurgery and Neonatology Coordinate a Rarely Done Surgical
Procedure on Infant
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A newborn boy who suffered from a rare malformation in his brain that
would have caused fatal congestive heart failure was treated
successfully by a team of physicians and surgeons at Jefferson and Wills
Eye Hospital .

The baby was born with an arterial venous fistula, or entangled cluster
of arteries, in his brain that was severely limiting the ability of his
heart to pump blood and subsequently would have killed him. The child
was born at Pennsylvania Hospital and transferred to CHOP, which then
sent him to Jefferson in a last-ditch effort to save his life using the
neonatology team and interventional neuroradiology expertise that are
available at Jefferson.

Jefferson surgeons accessed the interventional neuroradiology suite at
Wills Eye Hospital to operate on the child. In a technique similar to an
angiogram, the medical team fed a catheter through an artery in the
baby's leg and up into his brain. Imaging technology helped to guide the
surgeons as they positioned the catheter at the site of the fistula. 
They then injected liquid acrylic agents into the abnormal blood vessels
in order to seal off the excessive flow of blood.

The successful operation is thought to be the first of its kind in the
Delaware Valley.  "Having a team in place to take on this case paid
off," said Jay Greenspan, MD, associate professor of pediatrics at
Jefferson Medical College and acting director of neonatology at
Jefferson Hospital, who helped manage the baby's care. "Only the right
combination of doctors and staff here at Jefferson and the other
hospitals could do the job and give that baby a chance at life. We're
very proud and excited that we were able to help."

Robert Rosenwasser, MD, a Jefferson neurosurgeon and chief of
cerebrovascular and neuroendovascular surgery, performed the surgery and
noted that to begin with the odds were against the baby. "This is a very
rare condition. Although these fistulas can form anywhere in the body,
it is unusual to have to deal with them in the brain. The option of not
operating, however, would have been 100 percent mortality."

Dr. Rosenwasser explained that because the patient was so small, the
doctors were limited in how much contrast agent could be used to guide
the catheter. "We could only apply the equivalent of two tablespoons of
contrast to get the job done. We also had to be very careful about how
and where we injected the liquid acrylic. If we did it too soon, it
could have missed the mark and been fatal.  If it hardened too late, it
could travel to the lungs and also cause death."

Dr. Rosenwasser is one of five neurosurgeons in North America who can do
the procedure.  He noted that the material used, which is called NButyl
Cyano Acrylate, is similar to the ingredients in Krazy Glue . 

"The risks are significant, but we knew we had the best chance of
success with the technology and expertise we have available here," said
Dr. Rosenwasser. "We've used this surgical procedure with other types of
these arterial venous fistulas. But when the malformation grows in the
brain like this, the patient usually dies of congestive heart failure.
We were just able to mobilize everybody we needed - the neonatologists,
cardiologists, radiologists and neurosurgeons - to approach the problem
in the best way possible."

The baby is recuperating at home with his family.


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