Complicated neuro surgery performed on child

Neurosurgeons at KIMSHEALTH performed a transnasal endoscopic surgery on a one-and-a-half year-old girl who had been brought to the hospital in a comatose state and was diagnosed with life-threatening brainstem cavernoma, a rare congenital defect where a cluster of blood vessels in the brain becomes inactive, leading to haemorrhage.

A statement issued by the hospital said that transnasal endoscopic brainstem cavernoma removal was a highly complex procedure previously performed only in the U.S. and Japan and that according to literature, less than 20 such procedures had been performed worldwide. The mortality rate for cases involving ruptured blood vessels and brainstem bleeding is over 70%. The condition occurs in only 2.1 out of every 1,000 children.

Despite the inherent risks, the surgical team led by Ajith R., senior consultant, Department of Neurosurgery; and Vinod Felix, consultant, Endoscopic Skull Base Surgery and Rhinology; opted for Transnasal Endoscopic Transclival surgery for the brainstem cavernoma as this was the only viable option to save the child’s life.

The surgery was performed using a 4-mm endoscope, which was navigated through the nasal cavity to access the brainstem area. The area was then drilled open, and the defective blood vessels were identified and removed under endoscopic visualisation, relieving the baby of the compression.

Among the inaccessible areas

“This is one of the most inaccessible areas of the brain, and surgery in this region is extremely risky, as any accidental damage to the nearby cardio-respiratory centre could be fatal,” said Dr. Ajith.

The endoscopic approach through the nasal cavity to the brainstem region had perhaps not been attempted in the country and the challenge was compounded by the child’s smaller nasal cavity compared to that of an adult, said Dr. Felix.

An entire team of doctors from the departments of Neurosurgery, Neuro-anesthesia and ENT were part of the six-hour surgery.

The baby was discharged after a month’s stay at the hospital. She has made a full recovery and is on regular follow-up, the statement said.