In a remarkable medical achievement, doctors at Government Medical College and Hospital (GMCH) successfully treated a one-month-old infant, diagnosed with an extremely rare congenital brain vascular malformation, a double cerebral pial fistula, through a complex endovascular embolisation procedure. The intervention not only saved the infant’s life, but also preserved her vision. Paediatric cerebral pial fistulas are among the rarest cerebrovascular disorders in the world, with an estimated incidence of only 0.1–1 case per 1,00,000 population. Medical literature has documented fewer than 150 such cases globally till date. According to the treating doctors, there has been no previously reported case worldwide of two pial fistulas occurring simultaneously in the same neonate, making this an exceptionally rare presentation. The abnormality was first detected during a routine pregnancy ultrasound at 24 weeks, when doctors identified a vascular malformation inside the baby’s brain.

 

Following this, the pregnancy was kept under close monitoring. Delivery was carefully planned by the obstetrics team led by Dr Manjushree Waikar, Dr Ashish Zararia and team. Although the infant was neurologically stable at birth, doctors noticed mild protrusion of the eyes. Over the following weeks, the eye swelling rapidly worsened and eventually led to bleeding from the eyes. A CT scan performed at one month of age further revealed bleeding inside the brain too, making the condition life-threatening. Doctors explained that, such delicate procedures are usually delayed until infants are around 3–4 months old because performing neurovascular intervention in neonates carries extremely high risks.

 

However, due to the rapidly worsening eye condition, bleeding, and brain haemorrhage, the team decided to perform urgent life-saving treatment despite the infant’s very young age. The procedure was performed at the Bi-Plane DSA Lab of the Trauma Care Centre. The procedure was carried out by Dr Jawahar Rathod, Dr Shivprasad Jaybhay, Dr Shubham Yadav, Dr Aman Yusuf Khan, Dr Apoorvi Shah with support of the interventional radiology team, including Dr Arjun Anil, Dr Vishwas P, Dr Akarsh Chavan, Dr Nikhil Deshmukh, Dr Pranay Khedkar and Dr Nilesh Sinha, anesthesiologists Dr Vaijayanti Gadre, Dr Soma Cham and the dedicated nursing staff. Paediatric Intensive Care Unit (PICU) under Dr Ashish Lothe, Dr Manish Tiwari, ophthalmologists Dr Nilesh Gaddewar, Dr Dilip Kumare, neurosurgery team led by Dr Pramod Giri and Dr Sanjog Gajbhiye remained actively involved. The treatment was covered under Ayushman Bharat/ PMJAY scheme under the guidance of Dean Dr Raj Gajbhiye, Vice Dean Dr Devendra Mahore and Medical Superintendent Dr Avinash Gawande.