Twin in Womb Has Brain Surgery

One-week-old twin girls are doing “remarkably well” in Baltimore hospitals after doctors there performed experimental brain surgery on one infant before birth in a novel attempt to improve the survival chances of the other.

The surgery, performed July 22 at Sinai Hospital by a team headed by Dr. Phillip Goldstein, involved the insertion of a drainage tube through the womb of a pregnant woman and into the swollen skull of one of her unborn twins.

The baby suffered from a rare brain defect called hydrocephalus, or “water on the brain.” Doctors were concerned that the baby’s rapidly growing head was beginning to crowd the normal twin and increase the prospect of premature labor. The fetal surgery was performed to gain time by draining excess fluid from the baby’s brain.

Doctors at Sinai and Johns Hopkins University said Wednesday that their medical and ethical gamble appears to have paid off. The twins were born Aug. 11 by Caesarean section, and both are doing better than anyone had expected.

The delivery was still about six weeks earlier than normal, but Goldstein and his associates believe that their intervention helped gain crucial time in the womb and may have improved the prospects for both infants.

The normal twin is now breathing normally and nursing. Her sick sister still has an enlarged head but has shown no sign of nervous system impairment.