Given the multiple organs affected by the vein of Galen malformation, Miles’ treatment plan required a collaborative effort by a multidisciplinary team of providers across specialties throughout NewYork-Presbyterian/Weill Cornell Medical Center — in pediatric neurosurgery, cardiology, neonatology, and neurology.
“It really forces you to think about the entire body in a very complex fashion, and it calls upon the talents and skills of so many different types of specialists,” says Dr. Knopman.
The team might as well have been performing a juggling act on a tightrope; treating one organ could adversely impact another, and the younger the patient, the riskier it gets. That high degree of risk was enough for the neurosurgery team to initially recommend waiting until Miles was a little older — but then Miles gave them no choice but to act right away.
“He became more and more unstable from a pulmonary and heart standpoint,” says Dr. Knopman. “That kind of forced all of our hands to go ahead and address this while he was still really within the first few days of life.”
Addressing the malformation required closing off the abnormal connections between Miles’ arteries and veins in a series of procedures known as endovascular embolization. The procedures were spread over the course of three months to allow ample recovery time, since closing off the connections all at once could result in brain damage.