nat Al Zahra Hospital-1601899938483
Al Zahra hospital in Sharjah. The child was discharged on the 20th day, after recovering completely from the operation. Image Credit: Gulf News Archives

Dubai: In one of the most complex surgeries conducted on a newborn in the UAE, surgeons at Al Zahra Hospital, Sharjah hospital operated on a newborn baby with part of his brain outside the skull. The newborn’s mother, a 38-week pregnant Emirati female underwent a successful Caesarean section to delivery the baby after doctors detected an anomaly during a routine scan of the foetus.

Dr Hermann Honemeyer, fetal medicine specialist, discovered an ‘Occipital Encephalocele,’ in the expectant mother’s foetus. This meant that part of the foetus’ brain was outside his skull. This happens in one out of 5000 births in the world.

Unique case

The patient and family were then informed and counselled and a multidisciplinary team performed the operation. Having had three successful deliveries with the hospital in the past, the family opted to stay on despite being presented with various other options in the western world.

Once on-board, the patient was assisted by the hospital’s gynaecology team led by Dr Shama Nawaz, consultant obstetrics and gynaecology. The baby was successfully delivered and kept under extreme sterile conditions in the neonatal ICU, where a team of paediatricians constantly monitored the health of the baby.

Dr Nawaz said: “This case was unique. It was crucial to have a multidisciplinary team and an obstetrician who has dealt with a similar case in the past. In my 30 years of experience, this is only the second time I have encountered such a case. The time and mode of delivery was important as we were dealing with open brain tissue. We involved the parents, counselled them to make an informed decision.”

Breakthrough surgery

Dr Bobby Jose

To tend to the baby’s brain outside the skull, a team under Dr Bobby Jose, specialist neurosurgeon and clinical administrator, took over to perform the complex operation. In the first of the two-stage surgery, part of the brain lying outside the skull was carefully dissected and separated on the fourth day of the baby’s birth. The part was then placed back into the skull and an artificial membrane was used to cover the exposed part of the brain.

During the second part of the surgery performed on the eight day, the fluid gathered in the brain was drained out by performing a shunt surgery — where a tube was inserted from the brain into the stomach of the baby. To perform this surgery the baby was administered a high dose of anaesthesia, keeping it unconscious for several hours.

Speaking about this breakthrough surgery, Dr Jose said: “It was an extremely complex case considering the age of the child and how 30 per cent of the baby’s brain was outside the skull. The part had to be carefully handled and repositioned inside the skull and recreating the covering of the brain was an extremely delicate and intricate job. The anaesthesia for such a small child was very demanding, which was well handled by our anaesthesia team under Dr Hazem Daaji and Dr Ayman Hassan. The support of the paediatricians and neonatal team was very crucial in ensuring success of the surgery and outcome.”

Expert skills help safe life of baby

Dr Nisha Soares, consultant paediatrician, said: “The care of the baby was challenging, prevention of infection critical and establishing feeding of utmost importance. Our well-trained group of registrars and nurses who provided such dedicated care along with the parents who always worked in unison with us made it all possible. At the last clinic visit, when the baby smiled back at me, I felt gratified.”

The child was discharged on the 20th day, after recovering completely from the operation. Parents of the child were extremely happy with the outcome, especially considering the child’s slim chances of survival. Expressing his satisfaction on the overall success brought about the via teamwork, Michael Davis, CEO of NMC Healthcare, said, “Al Zahra Sharjah continues to serve the communities and I’m extremely proud of our team of dedicated doctors and surgeons performing this complex operation successfully and saving the life of the newborn.”