Mumbai: At just over a year old, Annas Raj has spent more time in hospital corridors than in parks and zoos. Diagnosed with Congenital Hydrocephalus at three months, he underwent three major surgeries at Fortis Hospital Mulund. Dr. Gurneet Singh Sawhney, Head of Functional Neurosurgery, along with Dr. Sameer Sadawarte, HOD & Sr. Consultant of Pediatrics & Neonatology, and their teams, provided his care. Annas has now made a full recovery and is back home, much to the relief of his worried parents.
Hydrocephalus is a medical condition where the Cerebrospinal Fluid (CSF) surrounding the brain and spinal cord accumulates in the brain. In healthy individuals, CSF flows through the ventricles and is absorbed into the bloodstream. However, in Hydrocephalus, this fluid does not drain properly, leading to an increase in fluid volume and pressure within the brain. This is a rare medical condition with an average of 2.75 cases per thousand.
Annas who lives in Bhiwandi with his parents and an older brother, was three and a half months old, when he began vomiting every time he was fed. His parents rushed him to a doctor who prescribed over-the-counter treatments for nausea, but his condition did not improve, he started losing weight rapidly. His parents noticed his head was swelling and he had ‘sunset eyes’, an ophthalmological condition where the eyes focus downward, and upward gaze is restricted. His worried parents rushed him to another doctor who diagnosed him with Hydrocephalus, and nothing was ever the same for him and his family.
“My happy-go-luck baby used to cry in pain throughout the day. We went ahead with his first surgery in May last year and the doctors inserted a shunt (a silicone tube inserted to carry CSF to a different body cavity for reabsorption). We began to feel hopeful when Annas showed signs of improvement, however, one and half months after surgery he fell sick again, the vomiting and sunset eyes returned, and he started losing his voice. We were worried, and on recommendation, we rushed him to Fortis Hospital Mulund,” recalled Annas’ mother, Mamta Kumari.
At Fortis Hospital, Mulund Annas was placed under the care of Dr Gurmeet Singh Sawhney and Dr Sameer Sadawarte. They found that the shunt which was in his brain was blocked. A blocked shunt can lead to accumulation of CSF and brain damage. Hence a new shunt was inserted on the opposite side of his head to help drain the accumulated CSF and he was discharged after a few days.
“Annas had to come back to Fortis for a second time and we found that the old shunt (placed during the first surgery) had broken off & slid inside the body, and a part of it was coming out rectally. As the shunt we had instead too was blocked, we facilitated External Ventricular Drainage (EVD), a temporary management of condition like Hydrocephalus. EVD entails placement of a catheter directly in the brain through a small hole in the skull. This catheter is connected to an external drainage system outside his body to help drain out accumulated CSF,” informed Dr Gurneet Singh Sawhney, Head-Functional Neurosurgery, Fortis Hospital, Mulund.
Dr Gurneet Singh Sawhney, added, “After two weeks of this procedure, we implanted an Ommaya reservoir to help manage his condition long term. An Ommaya reservoir is a small, dome-shaped vessel implanted under the scalp, which is connected to a catheter that is usually placed into one of the brain ventricles. The reservoir allows for repeated sampling of CSF for diagnostic purposes, as well as for the administration of medications directly into the fluid.”
Around three weeks after being continuously monitored his ventriculitis was cured, and Annas underwent a third procedure, an Endoscopic Third Ventriculostomy (ETV), which involves creating a new pathway for CSF to flow within the brain by using an endoscope. It is a long-term solution for conditions like Hydrocephalus.
“All through the three very complicated and extensive procedures what gave us courage to carry on was Annas and his fighting spirit. Even when he was extremely sick, he would smile at us and that pushed us to find the best possible cure for his concerns. His parents had faith in us and always gave us the go-ahead for every procedure, we even trained his mother on administering CPR in case of any emergency at home,” informed Dr Sameer Sadawarte, HOD & Sr. Consultant - Pediatrics & Neonatology, Fortis Hospital, Mulund.
Annas spent close to one month in the hospital after his surgery, and that is where he hit a major milestone - he turned one and the medical team at Fortis Hospital Mulund made sure to do their best to make this day special for him with a small celebration. Annas has since made a full recovery and is back home with his family. His mother still recounts the day of his suffering with trepidation, but she says their tribulations have only brought the family closer and his older brother has now taken on the role of a protector.