Guyana records first successful skull transplant surgery

Aug 27, 2020 News

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By Rehanna Ramsay

Annalisa Latchman, 24, a single mother from Lima, Essequibo, Region Two, was given a new lease on life after she became the subject of a successful skull transplant operation performed last Saturday.
The surgery – a first of its kind to be conducted in Guyana – was performed by prominent Guyanese neurosurgeon, Dr. Amarnauth Dukhi, at the St Joseph Mercy Hospital.

While speaking to the press via zoom yesterday, Dr. Dukhi noted that “the historic procedure,” was conducted following a careful examination and analysis of the patient’s condition.
The doctor first saw Latchman last July. At the time she had been suffering from excruciating headaches and had a growing indentation on her left side forehead due to her condition.The condition diagnosed as craniofacial fibrous dysplasia, Dr. Dukhi said, is a bone disease of the face and skull that replaces normal bone with fibrous tissue.
That tissue, the doctor said was not as hard as normal bone; it was more fragile and was pulling about 40 percent of the patient’s skull into her brain.
“That’s why she had the asymmetrical facial look where the left side was more indented into the brain and the right side was where it should be,” he added, noting that the condition can affect an afflicted person’s daily activities.

He added that the disorder could have severely disrupted the functions of Analisa’s brain if it had been allowed to progress.
“In Analisa’s case, her left eye had begun to recede noticeably,” Dr. Dukhi explained, adding that “her symptoms fit into the classical progression of the disease, which causes distortion of the face.”
According to Dr. Dukhi, the condition only occurs in 10-15 in every 100,000 babies born. The symptoms for persons suffering from craniofacial fibrous dysplasia begin to appear as early as two years old.
“Clinical signs of indentation commence between 10-12 years of age and as the patient begins to grow the signs of indentations become more pronounced,” he said.
Owing to the rarity of the patient’s condition and the fact that the treatment which was only available overseas could cost a minimum of US$200,000 – a sum the single mother could not afford – Dr. Dukhi decided to render his services free of cost and perform the surgery locally.
With the assistance of businessman and St. Joseph Mercy Hospital board member, Christopher Fernandes, Dr. Dukhi and his team were able to carry out the procedure for a fraction of the cost.
Latchman and her relatives were only required to come up with US$11,000—just about GYD$2M – and the remainder of the operational expenses was taken on by Mr. Fernandes and the hospital’s team.
To ensure that the team was equipped with everything necessary to carry out a smooth operation, Dr. Dukhi‘s clinic, NeuroSpine Services Inc., partnered with KLS Martin – a US-based company that creates implants for the entire human body.
The two companies, partnered to recreate an artificial partial skull needed for Latchman’s transplant.
Dr. Dukhi explained that to do this, KLS Martin was sent a 3D reconstruction of the CT-SCANS which they used as a guide to recreate the 40 percent of Latchman’s brain which was damaged by the craniofacial fibrous dysplasia.
“We were able to send that to KLS Martin and they actually reconstructed the 40 per cent of deficit that we would have been provoked during surgery in Analisa’s head. That was amazing because that is very difficult to do without actually seeing the patient’s head but thanks to technology and CT-Scans and MRIs, this is possible and because we have these resources in Guyana it is important that we use them and we use our human resource capacity as we continue to develop health care both in the public and the private sector,” he said.
He explained that although the surgery was a success, it was very risky.
“It was a very technical surgery because we had to go all the way on the eye at the orbit…Imagine part of her eyes is now into her brain and we were able to reset her orbit where it was. So, if you look at Analisa now she actually has a nice looking forehead not that indented forehead anymore. Her orbit is back in place and she has good vision.
It was tedious for me because it has two very important nerves that come out which is the facial nerve and the upper branch of the trigeminal nerve. We were able to dissect that very carefully and protect it so there were no injuries to her nerve so there were no repercussions in terms of who she was and her normal functions,” he added.
Given the outcome and the patient‘s recovery rate, Dr. Dukhi praised his almost all-female surgical team which included Dr. Anna Singh – his protégé neurosurgeon for the past five years.
The doctor also noted there were a lot of good Samaritans who helped make the surgery a success, particularly the St Joseph Mercy Hospital and Fernandes.
Dr. Sarah Lall Khan, a relative of the patient expressed her sincere gratitude to Dr. Dukhi and his team as well as the hospital and it staffers. She noted that Latchman had undergone severe suffering for months before Dr. Dukhi stepped in.
Dr. Lall Khan explained that her cousin had seen several doctors, ophthalmologists and neurologists – but no one could have diagnosed her condition.
“She had undergone several MRI and CT scans but all the doctors were treating her for was the pain which was the symptom because they could not find the source of the problem… but from the time Dr. Dukhi saw her, he diagnosed on the spot. He diagnosed her and came up with a treatment plan on our very first visit,” she said.
According to her, he explained that “cranio facial fibrous dysplasia, is a condition that babies are born with and showed us how the entire frontal lobe is being squeezed because of the bone pressing it back, causing the pain and abnormalities.”
“We are very grateful that she is no longer in pain and can go on to lead a normal life again,” Lall Khan added.
Chief Executive Officer (CEO) at the Mercy hospital, Deborrah Ramsay, said that the hospital is pleased to partner with Dr. Dukhi. She said the administration looks forward to more surgeries of its kind, including the possibility of Awake Brain Surgery.
“We are moving into an area of service coming from Dr. Dukhi in this hospital in a very 21st century way… I am so happy people don’t have to travel anymore to do this type of surgery that would cost them five times the amount that it would cost in Guyana. We are very pleased with the partnership,” Ramsay underscored.
Meanwhile, the mother of one who is on the road to full recovery and is expected to be discharged on August 27 also spoke to the media via zoom.
She expressed her happiness and gratitude to the team of doctors at the St. Joseph Mercy Hospital and all the donors particularly, Fernandes.
“Special thank you to Dr. Dukhi because I have visited so many doctors and got no help but the first visit to him, he told me about it and I must say that I am very grateful to him and special thank you to the Administration of St. Joseph Mercy Hospital and Mr. Fernandes,” she said.

 

 

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