Baby undergoes successful surgery to remove massive head mass at GPHC

A team of local doctors, last month, successfully removed a mass from an 11-day-old baby girl at the Georgetown Public Hospital Corporation (GPHC).
Little Shailah Ariya Persaud was born on September 19 with a rare Neural Tube Defect (NTD).

The neural tube forms the early brain and spine. NTDs occur when the neural tube does not close properly. These types of birth defects develop very early during pregnancy, often before a woman knows she is pregnant.
In a statement on Saturday, the GPHC explained that Altia Atkinson, a 34-year-old housewife of Reliance, Essequibo Coast, Region Two (Pomeroon-Supenaam), and her husband, Satesh Persaud, found out they were pregnant earlier this year.
Atkinson, already a mother of five healthy children, sought prenatal care at her community health centre. Her ultrasounds appeared normal and showed no cause for concern. It was not until she was admitted for the delivery of her sixth child that the ultrasound showed some irregularity. However, physicians at the Suddie Hospital were unable to determine if the mass/growth they were detecting was growing on Alita or her unborn child.

The woman went on to deliver her baby, via caesarean section (C-section), on September 19 at Suddie Hospital and was immediately referred to the Georgetown Public Hospital on account of a malformation that presented as a second head.
At just a few days old, Shailah was examined by Chief Neurosurgeon, Dr Amarnauth Dukhi, who quickly diagnosed the baby with a neural tube defect. After MRI scans of the brain and cervical spine were done, Dr Dukhi confirmed a rare Cranio-Cervical Junction malformation, a combination of the neural tube defects of the brain and spine as one, a Myelomeningocele-encephalocele occurring at the back of the head where the brain joins the spinal cord.
“While neural tube defects are quite a common birth defect, they usually occur on the head or the spine separately – in fact, the occurrence of encephalocele and myelomeningocele together as one defect in the same patient is rarely described in medical literature. In these uncommon cases the neural tube defect presents as sac-like protrusions on the brain and spine and are caused by the failure of the neural tube to close completely during foetal development, which may be attributed to several internal and external factors, mainly lacking the use of Folic Acid during pregnancy,” the GPHC explained.
According to the hospital, the management of encephalocele and myelomeningocele is often associated with numerous challenges including blood loss, cardio-respiratory disturbances and hypothermia. It was further noted that surgical intervention is critical to prevent hemodynamic fluctuations and excessive pressure on the sac which may result in premature rupture and eventual death.
To this end, Dr Dukhi led a multi-disciplinary team at GPHC on September 30 to separate this large malformation from the baby’s head and repair the defect at the junction where brain and spinal cord are joined.
The GPHC revealed that “This tedious and complicated medical intervention for Shailah commenced firstly with the placement of VP shunt for the developing hydrocephalus that was also diagnosed. The large malformation/mass, the size of the normal head was then carefully separated from the head and upper cervical spine. This was followed by the reconstruction of the craniospinal junction’s defect to prevent the leakage of cerebrospinal fluid and allow for normal development of the brain and spinal structures”.
After the more than six-hour procedure, Dr Dukhi and his medical team deemed it a successful one.
Following seven days of neonatal post-operative care, little Shailah was discharged into her mother’s arms without any obvious neurological deficits and is expected to lead a normal childhood.
However, close monitoring will be done to determine any difficulty in the child’s developmental curve.