3-month-old undergoes skull deformity surgery in UAE

The baby after the surgery

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.
Craniosynostosis (from cranio, cranium; + syn, together; + ostosis relating to bone) is a birth defect which causes premature fusion of one or more of the fibrous sutures, changing the growth pattern of the skull. It occurs before the infant's brain fully forms, and 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.

Consultant neurosurgeon Dr C V Gopalakrishnan
So what does the surgery entail?
"Strips of bone are removed so that the skull starts growing 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 degree of deformity. At the end of the period, it helps the skull get a normal rounded shape," the doctor revealed.
The procedure in this child was done via two small skin cuts, one placed behind the soft spot and the other placed further back on the infant's scalp. While the endoscope - a thin, lighted tube with a camera - was used to expose the affected suture, the involved bone was removed, allowing the baby's brain and skull to expand and reshape normally."
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 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