Pediatric neurointerventional surgery may be the most difficult and most rewarding subspecialty within the SNIS. As a neurointerventionalist whose practice includes treatment of infants and children with cerebrovascular disorders, I have the privilege of helping families through challenging times. Some of my most memorable patients have been neonates with heart failure due to high flow intracranial arteriovenous fistulas. These cases draw upon not only the technical expertise of interventionalists, neonatologists, anesthesiologists, nurses, and radiologic technologists, but also the emotional resources of the entire team and the patients’ families. Over twenty years ago I wrote “…And Do No Harm” with Grant Hieshima, one of the fathers of our field, on how physicians can deal with grief over adverse outcomes in their patients. Last year, I cared for a baby whose brief life inspired those around her.
Savannah Branch was a beautiful baby with a vein of Galen malformation. Savannah was diagnosed prenatally, in the last few weeks of gestation, and her mother came to UCSF to deliver her. In the first days after her birth, Savannah had minimal signs of heart failure and interacted with her parents in the neonatal ICU. She was able to breast feed despite umbilical artery and umbilical venous lines being in place in anticipation of the need to treat the intracranial fistula should her heart failure worsen. Savannah’s tachypnea and oxygen requirements increased on her sixth day of life. By her eighth day of life, Savannah’s heart failure became unstable despite medical management. Working as a team, our neurointerventional group operated on Savannah, achieving a significant reduction in arteriovenous shunting and decrease in her central venous pressures and heart failure. We thought we had achieved success, and shared our optimism with Savannah’s parents. Later that night, our hope gave way to frustration, as Savannah had a seizure and imaging demonstrated intracranial hemorrhage. After a tearful family meeting, Savannah’s parents were resolute in their concern for her future brain development and chose to take her home for palliative care. They flew back home and Savannah passed away peacefully on her tenth day of life.
To remember her and to improve the clinical care of infants and children with disorders of the blood vessels of the brain, the Savannah Branch Memorial Fund for Pediatric Cerebrovascular Research was established in 2017. Existing within the SNIS Foundation, the Savannah Branch Memorial Fund seeks to support research into the underlying causes, diagnostic techniques, prognostic imaging, and treatment of pediatric cerebrovascular diseases.