A one-and-a-half-year-old girl with a rare congenital condition known as brainstem cavernoma made a full recovery after a groundbreaking Transnasal Endoscopic Brainstem Surgery performed at KIMSHEALTH Trivandrum. This marked the first successful execution of such a procedure in India.
Brainstem cavernoma (BSC) is a rare congenital defect characterized by a cluster of blood vessels in the brain becoming inactive, leading to bleeding. The child was brought to KIMSHEALTH Trivandrum in a comatose state and gasping for breath.
She had also experienced weakness on the right side of her body for several months prior. Upon admission, she was immediately placed on ventilator support. Given the severity of her condition, the surgical team performed a transnasal endoscopic brainstem cavernoma removal—a highly complex procedure previously attempted only in the US and Japan.
According to available reports, fewer than 20 such surgeries have been performed worldwide. The mortality rate for cases involving ruptured blood vessels in the brainstem exceeds 70 per cent.
The surgical team, led by Dr. Ajith R, Senior Consultant, Department of Neurosurgery, and Dr. Vinod Felix, Consultant, Endoscopic Skull Base Surgery and Rhinology, opted for Transnasal Endoscopic Transclival Surgery as it was the only viable option to save the child’s life despite its significant risks.
The surgery involved navigating a 4mm endoscope through the nasal cavity to access the brainstem. The clival area (near the base of the skull) was drilled open, allowing the surgeons to locate and remove the defective blood vessels under endoscopic visualization, relieving the compression.
“This is one of the most inaccessible areas of the brain, and surgery in this region is extremely risky, as any accidental damage to the nearby cardio-respiratory centre could be fatal,” explained Dr Ajith.
Dr Felix added, “The endoscopic approach through the nasal cavity to this region has been attempted at only a few centres in the United States and Japan. This is the first time such a surgery has been performed in the country, and the challenge was compounded by the child’s smaller nasal cavity compared to that of an adult.”
Dr Abu Madan, Dr Navas N.S., and Dr Bobby Iype from the Department of Neurosurgery, Dr Susanth B from the Department of Neuro-anesthesia, and Dr Bency Benjamin from the Department of ENT were also part of the six-hour-long surgery.
After a month-long stay in the hospital, the baby was discharged and has since made a full recovery. She now walks independently to outpatient follow-ups and continues to be under regular observation.
