Complex neurosurgery performed on a child

Neurosurgeons at KIMSHEALTH performed endoscopic transnasal surgery on a one-and-a-half-year-old girl who was brought to the hospital in a coma and diagnosed with a life-threatening brainstem cavernoma, a rare birth defect in which blood vessels in the brain stop working, leading to bleeding.

A statement issued by the hospital said that transnasal endoscopic brainstem cavernoma removal was a very complicated procedure that was previously performed only in the US and Japan and that according to the literature, less than 20 such procedures were performed worldwide. The mortality rate for cases involving ruptured blood vessels and brain hemorrhage is over 70%. This condition occurs in only 2.1 out of 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; they chose Transnasal Endoscopic Transclival surgery for 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 passed through the nasal cavity to reach the brain area. The area was then punctured and opened, and the defective blood vessels were identified and removed under endoscopic visualization, relieving the baby of pressure.

Among the inaccessible places

“This is one of the most inaccessible areas of the brain, and surgery in this region is very dangerous, as any accidental damage to the nearby heart-breathing center may be fatal,” said Dr. Ajith.

The endoscopic method through the nose to the region of the brain was perhaps not tried in the country and the challenge was compounded by the small nasal cavity of a child compared to an adult, said Dr. Felix.

The entire team of doctors from the departments of Neurosurgery, Neuro-anesthesia and ENT were part of the operation for six hours.

The child left the hospital after staying for a month. He has made a full recovery and is being monitored regularly, the statement said.