Rare skull surgery on three-month-old
abu dhabi — Paediatric healthcare in the UAE achieved a major milestone with the first successful endoscopic -assisted, minimally invasive surgery for an abnormal skull growth case in a young child.
The landmark craniosynostosis surgery was performed on a 3-month-old child from Brazil born with an abnormally shaped head at NMC Royal Hospital by consultant neurosurgeon Dr C V Gopalakrishnan.
It wasn’t just the oddly shaped skull, but also the presence of a fibrous connective tissue joint between the two parietal bones of the skull — known as sagittal suture — that required surgery.
The condition causes premature fusion of one or more of the fibrous sutures, changing the growth pattern of the skull. Unable to expand perpendicularly, the skull compensates by growing more in the direction parallel to the closed sutures, often resulting in an abnormally shaped head and sometimes, even facial features.
“This can lead to two problems: firstly, it can be cosmetic and secondly, if unchecked it can later lead to cognitive problems affecting the child’s intellect as the brain is unable to develop normally,” Dr Gopalakrishnan told Khaleej Times.
Craniosynostosis can be diagnosed with a simple clinical examination, with a further 3D CT scan only for atypical findings and to assist in surgery planning.
So what does the surgery entail?
“We open up these bones so the skull starts growing more normally. After the surgery, the child is put in a helmet that provides the skull an external structure to grow in a definitive way. The helmet can be kept on from between six months to a year, depending on the deformity. It helps the skull get a normal rounded shape,” the doctor revealed.
The doctor stated that corrective surgery in such cases must be done within the first three months of the infant’s life. The next available opportunity is when the
Restoring the normal appearance of the skull improves the parent–child relationship and prevents severe psychosocial trauma resulting from the deformed head.” Dr C V Gopalakrishnan, consultant neurosurgeon, NMC Royal Hospital
baby is about nine months old, to perform an open operation with a large skin incision and major manipulation of the skull bones. “Since rapid growth of the brain occurs over the first three to six months of life, endoscopic surgery needs to be performed early,” Dr Gopalakrishnan noted.
Early diagnosis and operating soon after birth allows for the endoscopic technique. Its advantage over the traditional open method is much less bleeding, doing away with the need for blood transfusion in most cases. The operating duration and hospital stays are also shorter.
Dr Gopalakrishnan said: “The surgery has many benefits. Restoring the normal appearance of the skull improves the parent–child relationship and prevents severe psychosocial trauma resulting from the deformed head.”
Prasanth Manghat, CEO of NMC Healthcare, remarked on the hospital case: “Considering that the family had the access to options worldwide, this surgery can open up avenues for medical value tourism coming into our country.”
Muniz, the child’s father, said: “I am extremely thankful to NMC and Dr Gopalakrishnan. After a few anxious moments, my child was stable and safe. I thank God every day for guiding me to this hospital, since very few healthcare facilities have the necessary expertise for such complex and high risk neurosurgery.”
saman@khaleejtimes.com