Keyhole surgery performed on 4-month-old boy with large head

The conventional tube surgery done using a long silicon tube diverting the fluid from brain cavities to abdominal cavity is thus avoided in this baby, the release said.Subsequent to the procedure babys neurological status improved remarkably, with near normal eye and limb movements to the delight of the parents.

Doctors in a city hospital have saved a four-month-old baby with a large head by a path- breaking key hole endoscopic bran surgery. The premature baby with a large abnormal head and neurological deficits was referred to KMCH for expert management.

The baby, one of the twins weighing only 800 grams at the time of birth, showed progressive increase in head-size and down-rolling eye balls and abnormal limb movements that alarmed the parents to seek medical advice. The baby was seen by a team of doctors and evaluated the newborn with MRI and diagnosed the child with having congenital hydrocephalous, a condition in which the fluid cavities were dilated abnormally with locked-up brain fluid called cerebro spinal fluid, a KMCH press release said on Friday.

This profound locked-up fluid in the natural cavities produces unprecedented pressure exerted on the neural tissue leading to neurological deficits, incapacitating the baby and finally leads to death, the release said. This condition that may not be treated with medical management warranted diversion of the fluid from the cavities immediately to save the child.

While the baby that recovered from COVID-19 on admission was found to have abnormal electrolyte disturbances and that was effectively managed in the neonatal intensive care unit. Dr J. K. B. C. Parthiban, senior neurosurgeon and course director of National Board of Education for Neurosurgery at KMCH, performed a keyhole endoscopic brain surgery to divert the locked-up fluid within the drainage system thus bypassing the congenital block in the cavities.

This technique is unique in establishing normal fluid circulation in the brain and reduces the pressure in the cavities. The conventional tube surgery done using a long silicon tube diverting the fluid from brain cavities to abdominal cavity is thus avoided in this baby, the release said.

Subsequent to the procedure baby's neurological status improved remarkably, with near normal eye and limb movements to the delight of the parents. The keyhole surgery is called endoscopic third ventriculostomy (ETV) is an established endoscopic procedure and not new. The technique is challenging but good for patients, particularly in this type of cases where the baby was underweight at birth and emaciated and post-COVID-19 status.

The procedure can be done in neonates, babies less than one year of age , comfortably. Risk of any surgical procedure in premature babies before four months is a great challenge and can be done only with a team work, Parthiban said.

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