After a surgery that lasted 13 hours, a multidisciplinary group of ISSSTE doctors corrected a craniofacial malformation in a premature baby from Yucatán in Mexico City.
The alteration is the largest and most complex of this type treated in 40 years at the “20 de Noviembre” hospital, reported the general director, Pedro Zenteno Santaella. The patient was little Paloma Alhelí, originally from Mérida, who had fronto-naso-ethmoidal encephalocele.
Neffely Alhelí Canul Heredia, the girl’s mother, shared that they went through difficult moments of uncertainty. “We knew that our baby’s case was very complicated.”
Juan Adrián May Mex, the father, expressed: “My daughter’s case is a medical miracle. In these five months that our girl was in the hospital, the doctors and nurses became part of our family.”
The medical team that treated the little girl was neurosurgeon Ricardo Valdez Orduño; pediatric anesthesiologist Juan Carlos Torres Carrillo; maxillofacial surgeon Laura Leticia Pacheco Ruiz; plastic surgeon Daniel Reyes Cureño and neonatal intermediate and intensive therapy neonatologist Manuel Cázares Ortiz.
The little girl was born at the Issste Regional Hospital in Mérida, where she spent her first days of life before they took her to the capital hospital.
Neurosurgeon Valdez Orduño, leader of the surgical treatment team, explained: “After a month of planning, on May 17 we carried out the surgery. It consisted of removing the larger extension sac from the girl’s head, which contained non-functional brain tissue.
“The most important challenge was to correctly close the cranial defect to prevent brain tissue and its components, or cerebrospinal fluid, from continuing to leak out, with the risk of complications such as fistula formation, infection, and even death.” The size of the defect warranted a transposition of the bone towards the base of the skull to support the brain, he explained.
“When the little girl arrived at the hospital we didn’t know if it would be possible to find treatment. The incidence of these malformations is one per 25,000 to 30,000 births in the world, but as large as this it is extremely rare. That the doctors achieved a viable surgical treatment for her is an exceptional achievement,” declared neonatologist Manuel Cázares Ortiz, in charge of the patient’s care in intensive care, where she remained for two months.
Surgeon Laura Leticia Pacheco explained that given the serious case—and summoned by doctor Valdez Orduño—they requested a 3D model to identify the extent of the malformation and all affected or absent cranial bone structures, which helped to carefully plan the procedure surgical procedure and request special supplies to carry it out.
“We decided to take a parietal bone graft to position it at the base of the skull. As planned, the removed frontal bone was segmented into three fragments, two lateral and one medial, which we mobilized inferiorly to close the nasal defect since she did not have nasal structures, and with this, we formed them.”
Subsequently, plastic surgeon Daniel Reyes Cureño reconstructed the soft tissues. “It was an operation to cover the defect based on the mobilization of local flaps, with very good results; Although it involved the closure of a very large wound, the healing has been very good and is currently barely noticeable.” Anesthetic management was a challenge, said Juan Carlos Torres. “We had high moments: the risk inherent to a premature baby with a complex malformation; “Extreme care in initial maneuvers to ensure that he breathed throughout the surgery and protected vital organs and lungs, ensuring a better post-surgical prognosis, in addition to ensuring that he did not feel pain in 13 hours of multiple intervention.”
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