For the very first time in Costa Rica, the San Juan de Dios (HSJD) and Nacional de Niños (HNN) hospitals performed open prenatal surgery to repair a lumbosacral myelomeningocele. After a timely diagnosis and careful planning, specialists from both hospitals underwent surgery on the mother and the 27-week gestational baby with the aim of addressing the congenital malformation of the latter without stopping its development in the womb.
The surgery was carried out by 5 specialist surgeons; 2 of them in maternal-fetal medicine; 1 in fetal medicine, and 2 in pediatric neurosurgery. The preparation of surgeons to perform this type of surgery required more than five years of training both nationally and internationally, in health establishments in Barcelona, London, Chicago and Houston. Additionally, this surgery had the support of a center specialized in this type of surgery in Mexico, directed by the neurosurgeon Felipe Chavelas Ochoa.
Surgery consists of operating on the baby by opening the mother’s abdomen and uterus. Subsequently, the congenital malformation is repaired by the team of neurosurgeons and the closure of the mother’s uterus and abdomen is concluded so that the pregnancy can continue.
The team of surgeons was led by Dr. Joaquín Bustillos Villavicencio, head of the San Juan de Dios Obstetrics service, and was made up of: Dr. Yai Linn Chang Castro, a specialist in fetal medicine, Dr. Leonardo Jiménez Fernández, a specialist in maternal fetal medicine, both from the HSJD, Dr. Adrián Cáceres Chacón, specialist in pediatric neurosurgery and Dr. Juan Luis Segura Valverde, specialist in pediatric neurosurgery; the latter are from the HNN.
Doctor Bustillos highlighted the importance of this operation for the baby’s quality of life. “With this surgery, this baby can improve his neurological condition in such a way that he requires fewer surgical interventions after birth since it is known from international experience that the possibility of developing hydrocephalus is significantly reduced and there could even be an improvement in leg mobility and the control of urinary or intestinal continence, which will definitely positively impact the quality of life”, he added. In addition, he added that the baby “is less likely to require the placement of a valve to control excess fluid in the brain, which is called hydrocephalus. When we operate in the uterus, many malformations of the brain reverse, so in addition to reducing the possibility of developing hydrocephalus, an improvement in the cognitive part has also been described, that is, it improves their intellectual performance.
Everything used in the operation was latex-free because it has been medically proven that fetuses are sensitive to the product. This surgical procedure lasted approximately three hours, with more than 50 collaborators in the different stages of the process, distributed among the areas of: Gynecology, Perinatology, Neonatology, Intensive Care, Blood Bank, Anesthesiology, Nursing and Operating Room, the San Juan de Dios and Nacional de Niños hospitals and the National Center for Magnetic Resonance.
Dr. Adrián Cáceres Chacón, neurosurgeon at the Spina Bifida (myelomeningocele) Clinic of the National Children’s Hospital, emphasized that Costa Rica is a leader in research for the prevention of this type of congenital defects thanks to the project called Food Fortification, with which the country adds folic acid to the nutrients of the entire population. “It began first by fortifying wheat flour in 1997; then corn, rice and, finally, dairy products. We are one of the few countries in the world that preventively fortifies four nutrients for the protection of the entire population”, he noted. This is important since the vast majority of neural tube closure defects are associated with folic acid deficiency and, to a lesser extent, with genetic causes. The procedure was performed on January 12th, just 10 days later the mother began the labor process. She underwent a cesarean section without major complications and the baby was admitted to the Neonatology service of the San Juan de Dios hospital for its clinical evolution. Up to now, her surgery’s recovery has been satisfactory.
