UAE-based surgeon performs rare procedure to help boy with skull fracture

Dubai: An 11-year-old Iraqi boy living with a skull fracture all his life recently got a special patch on the injury during an innovative surgery at a hospital in Dubai, allowing him to lead a normal life.

Mohammed Munef Turfah no longer needs to worry about brain swelling or water retention, thanks to the procedure carried out by Dr Imad Hashim Ahmed, consultant neurosurgeon at Canadian Specialist Hospital Dubai.

Mohammed underwent a cranioplasty surgery to repair cranium defects on the skull.

Injured as a baby

Dr Ahmed, who has conducted such surgeries in war zones including in Iraq, said his patients routinely came in with horrific shrapnel injuries and missing skin or bone. However, Mohammed’s situation was a rare case for UAE, he added.

“Following a fall, the boy had suffered a depressed fracture to the occipital are of the skull when he was just six months old. Since then, his fracture had progressed. He had undergone a few surgeries in his country to manage the injury,” said Dr Ahmed.

Further complications

Due to the trauma to the skull, the child also suffered hydrocephalus soon after the injury. Hydrocephalus is an abnormal buildup of Cerebrospinal Fluid (CSF) in the ventricles (cavities) deep within the brain. This excess fluid causes the ventricles to widen, putting pressure on the brain’s tissues. CSF is the clear, colourless fluid that protects and cushions the brain and spine.

Dr Ahmed said, in Mohammed’s case, the Hydrocephalus was a direct result of his skull fracture that had triggered build-up of CSF. The child underwent surgery to have a shunt placed to drain out the fluid.

First intervention

The family first visited Dubai to consult with the neurosurgeon in 2014, as the child was hyperactive. “Then, his CT scan showed a large defect on the back of his skull. He underwent Cranioplasty and we closed the defect with a mesh in January 2015. He recovered well and returned to Iraq.”

However, in July his father noticed swelling in the affected region of his skull and upon examination it was found that the mesh was damaged. Therefore, the family revisited Dr Ahmed seeking a second surgical intervention.

Closing the skull gap

This time, the CT scan confirmed that the mesh had broken down at some points. Dr Ahmed said: “Therefore, I decided it would be better if we could place a custom-built piece belonging to the acrylic family, which is as hard as bone, on the site. This is made from a very tensile material called Polyeretherketone [PEEK]. The PEEK material is used in hip and other joint fractures and is being used in skull fractures since 2000. It has properties of being bio-compatible, is resistant to thermal and ionising radiation and resembles the cortical bone bio-mechanically. We sent his CT scan to USA and had the piece custom-made to individual specification to fit the exact contours of his skull.”

The surgery was conducted on September 19; the young boy showed immediate improvement and was discharged within a couple days, the doctor added. The family returned to Iraq within a week of the latest surgery.