CASES OF THE WEEK - “A baby born with part of the brain outside the skull saved by complex surgery” by Dr Bobby Jose, Specialist NeuroSurgery; Dr Nisha Soares, Consultant Paediatrics; Dr Shama Nawaz, Consultant, Obstetrics & Gynaecology, Dr Wissam Al Tamr, Specialist Paediatric Surgery and Dr Ayman Moustafa Hassan, Consultant Anesthesiology, NMC Royal Hospital Sharjah

Mrs M, a lady who was 38 weeks pregnant came to Al Zahra Hospital with an antenatal diagnosis of myeloencephalocoele, which means part of the brain of the baby is lying outside the skull. On the same day of presentation she went into labor and the challenge was to deliver the baby with a part of the brain lying outside the skull without causing injury.

Determined to save the baby, the gynaecology team under Dr Shama Nawaz, Consultant Obstetrics & Gynaecology decided to go in for Caesarean section even though the mother was in labor , as normal vagina delivery is likely to damage the brain, making survival of the child impossible.

The child was delivered successfully and was kept in extremely sterile conditions in the neonatal ICU under the care of Dr Nisha Soares, Consultant Paediatrics, then a complex two stage surgery, requiring extreme precision and long hours was planned by the Neurosurgery team led by Dr Bobby Jose, Specialist Neurosurgery.

In the first stage when the baby was 4 days old the part of the brain lying outside of the skull was carefully dissected and separated and was put back in the skull and an artificial membrane was created to cover the brain. Then the skin was mobilized from the surrounding scalp and normal skin closure was achieved.

In the second stage 3 days later the fluid collection in the brain was drained by doing a shunt surgery and a tube was put from the brain into the stomach of the baby. This was done by a surgical team Led by Dr Bobby Jose and Dr Wissam, Specialist Paediatric Surgery.

Longtime Anesthesia in such a small baby was indeed a challenge which was successfully performed by Dr Ayman Moustafa Hassan, Consultant Anaesthetist and Dr Hazem Daaji, HOD & Consultant Anaesthetist.

The post-operative Care was demanding requiring a great deal of time and care following such a complex surgery but it was brilliantly carried out by the Neonatology team under Dr Nisha and the nursing team led by Sister Leni. The child was discharged on the 20th day of life and is doing extremely well. The parents were extremely happy with the organized team work at Al Zahra which could save the child which otherwise was given a very small chance of survival.

The parents whole-heartedly thanked the medical team at Al Zahra Hospital Sharjah led by Dr Bobby Jose, Dr Nisha Soares, Dr Shama Nawaz, Dr Wissam AlTamr, Dr Ayman Moustafa Hassan and Dr Hazim Daaji.