In a groundbreaking medical achievement, a 19-day-old infant has successfully undergone coil embolisation for an intracranial aneurysm, setting a precedent as the first procedure of its kind in such a small baby in India.
Aishwarya Agare (25) and her husband Jayesh were overjoyed with the arrival of their first son, who weighed 3.5 kg and was born on May 18, 2024, through a normal vaginal delivery. Hailing from Ratnagiri, the couple's excitement quickly turned to concern when their newborn experienced a fever and increased respiratory distress, necessitating oxygen support. The Sepsis screen was positive and the baby was treated with IV antibiotics for the same. The 10-day-old full-term baby was admitted with complaints of early-onset sepsis and completion of antibiotics for the same.
The baby had an acute life-threatening bleed on the 12th day of life in the NICU, the baby turned limp and apneic with bradycardia for 10 minutes following breastfeeding. The baby was started on bag and mask ventilation and subsequently intubated and put on mechanical ventilation.
The MRI Brain showed that the baby had a small balloon-like bulge in a blood vessel in the brain. This bulge measuring 9.7 x 9.5 x 8.3 was about the size of a large marble and was located where two major blood vessels in the brain meet with bleeding in the area around the brain and also between the layers covering the brain, caused by the aneurysm bursting.
Open neurosurgical intervention such as clipping of the aneurysm was not practically feasible because of the location of the aneurysm. The decision was taken to go ahead with endovascular coiling of the aneurysm by an interventional neuro-radiologist as it is a less invasive procedure and was the only feasible option for this baby. The parents were explained the risks and benefits of the procedure and the possibility of parent artery occlusion if needed.
The baby underwent endovascular coiling on the 19th day of life via the femoral route. Multiple platinum coils were deployed into the aneurysm sac. While complete occlusion of the aneurysm was not achievable without also occluding the left internal carotid artery, the procedure successfully stabilized the baby. Post-procedure, imaging confirmed the occlusion of the carotid artery.
According to the Bai Jerbai Wadia Hospital, this is the first reported case of intracranial aneurysm presenting in the neonatal period in India. This is also the youngest baby (19th day) to undergo coil embolization of intracranial aneurysm in India.
The baby was carefully monitored and stabilized in the Neonatal Intensive Care Unit (NICU), where he received oral nimodipine and IV magnesium sulfate to manage cerebral vasospasm.
An Ommaya reservoir was placed to address post-hemorrhagic hydrocephalus. The baby was extubated on the 5th postoperative day and transitioned to non-invasive support, eventually breathing room air. Following extubation, early intervention and physiotherapy were initiated. The baby completed a 6-week course of IV antibiotics and antifungals, followed by the placement of a VP shunt.
Jayesh Agare, baby’s father, said, “What began as a moment of happiness quickly spiraled into a distressing ordeal when our newborn started experiencing seizures just ten days after his arrival. The overwhelming fear of losing him consumed us, and we found ourselves in tears. His condition deteriorated rapidly, but we are incredibly grateful to the dedicated team of doctors who fought to save his life. We will always be thankful to Wadia Hospital for their swift action, exceptional expertise, and outstanding care.”
Dr. Minnie Bodhanwala, CEO, of Wadia Hospitals, said, “The successful coil embolization of an intracranial aneurysm in only a 19-day-old baby at Wadia Hospital marks a pivotal moment in pediatric interventional neuroradiology. Experts have not only demonstrated advanced medical capabilities but also showcased their capacity to handle complex cases with compassion and care. This case symbolizes the relentless pursuit of excellence that defines Wadia's approach in ensuring even the youngest patients receive world-class care tailored to their specific needs.”
