–after undergoing first partial skull transplant surgery in Guyana

By Nafeeza Yahya-Sakur

DAYS after completing yet another historical surgery, Guyana’s leading neurosurgeon has his eyes set on performing a brain surgery, where the patient is awake and responding as he operates.

Dr. Dukhi made the announcement at a press conference at the St. Joseph Mercy Hospital on Wednesday, as he told reporters about the recent successful surgery he performed, pro-bono, on a single-parent of one on Saturday.

The patient, Analisa Latchman, 23, of Lima, Essequibo Coast was diagnosed in July 2020 with a rare Craniofacial Fibrous Dysplasia that usually occurs in 10-15 of every 100,000 persons born worldwide.

Prior to Saturday, a surgery of this nature could have only been performed in developed Caribbean countries, or First World nations, and usually costs approximately US$200,000.

But thanks to the benevolence of Dr. Dukhi, through NeuroSpine Services Inc, St. Joseph’s Mercy Hospital, businessman Chris Fernandes and other anonymous donors, Analisa and her family just paid for the 3D replacement, which cost US$11,000, or G$ 2.3M, and a little over G$1M for hospital fees.

Analisa, according to her cousin Dr. Sara Lall Khan, had from the age of 10 noticed an indentation on the left side of her head, which started to become more pronounced as she aged.

Gradually, her eye began to recede into her head, coupled with headaches that eventually got progressively worse, to the stage that she fainted.

Dr. Khan explained that initially, the family thought the headaches were caused by the eye, and saw several ophthalmologists, but were only told Analisa had good vision, and was given pain medications to help with the headaches. Several other doctors were visited multiple times, including a neurologist. Numerous tests and scans were performed, but none were able to properly diagnose the condition.

The family had all but given up hope after the pain medications were not helping the headaches, and Analisa’s symptoms worsened. But then they decided to reach out to Dr. Dukhi, who, after listening to her history, was able to identify the condition immediately.

TEXT-BOOK SYMPTOMS

In an interview with the Guyana Chronicle, Dr. Dukhi related that Analisa displayed “textbook symptoms” of the disease, and was able to make the diagnosis immediately, but ordered a MRI to confirm.

“The patient is a 23-year-old mother of one who noticed, from around 10 to 11 her face and skull was deformed, so to speak, where the left side of her face and skull was convoluting, or getting smaller, while her right side of her head was just normal,” Dr. Dukhi said, adding: “So it provoked severe cranial facial deformity, where her left eye was being pulled into her skull. What happened was because the left side was continuing to get smaller, it was squeezing the developed brain inside her head, causing her to have severe headaches, which would have led to brain damage by the compression. And that would have led to seizures and other complications eventually.”

He said that the disease usually starts when patients are around three years old, and gets worse in the latter teen years and early twenties. He noted that Analisa’s condition progressed over the past couple of years, and the disease affected the frontal bone, temporal bone on the left side, and parietal bone, which accounted for 40 per cent of her left skull.

Surgery was the only option to give Analisa a chance at having a normal life, and after the family expressed some concerns about financing, Dr. Dukhi offered to perform the surgery, pro-bono, while the family takes care of the other cost.

A CT-scan was performed, and a 3D image of Analisa’s head was reconstructed and sent to one of NeuroSpine’s international partner, KLS Martin, in the United States, where an implant was created to perfectly replace the section of the skull that was no longer viable.

The implant, according to Dr. Dukhi, arrived on Thursday, and on Saturday morning, a six-hour surgery, with a six-member team consisting of mostly females, including Dr. Anna Singh, who he has been training for the past five years, successfully performed the procedure to remove and replace the affected left section of Analisa’s head.

Dr. Dukhi noted that the surgery was a technical and tedious procedure, and as with most neuro-surgeries, any mistake can be life-altering for the patient.

“It was a very technical surgery, because we had to go all the way to the eye and the orbit. Imagine part of her eye is now into her brain,” Dr. Dukhi said, adding: “We were able to reset her orbit to where it was, and if you look at Analisa now, she will have a nice-looking forehead; not that indented forehead anymore. Her orbit is back in place… It was tedious for me, because it has two very important nerves that come out from the area where we had to work, which is the facial nerve and the upper branch of the trigeminal nerve. We were able to carefully dissect that right away, and protect the nerves. And there were no repercussions to her, in terms of who she was or her normal functions.”

RECOVERING WELL

Following the surgery, the patient is recovering well, and Dr. Dukhi is optimistic that she should be able to lead a normal life.

When quizzed by this publication on what the historical surgery meant for healthcare in Guyana, Dr. Dukhi expressed satisfaction at the progress made thus far, and optimism that the country is in strong contention with more developed nations in the field of neurosurgery.

“I personally would like to speak for neurosurgery, of which I have been the pioneer since 2015,” he said. “The procedure we would have done is extremely huge for our country, in the sense that it is now being done locally, what was previously done in more developed Caribbean islands like Trinidad and Tobago, or First World countries. I would say we are taking huge baby steps in terms of developing modern healthcare, and hence improving our health response at a tertiary level, or more specialised care. So, it’s moving ahead, and we are getting there. And I’m hoping that sooner or later, we will be on par with what is happening in more developed nations.”

Meanwhile, Analisa Latchman said she is very grateful to all the donors who helped to make her surgery a success, and looks forward to returning to work, so that she can provide for her daughter.

The surgery was a collaboration between the St Joseph’s Mercy Hospital and NeuroSpine Services Inc., which is the local partner for Vision Medical Limited of Trinidad and Tobago, and representative of KLS Martin in the United States.

They have been leaders in the field of neurosurgery and spinal care in Guyana. Setting his sight on the awake brain surgery next, Dr. Dukhi stated that the Guyanese company was created to offer First World services to Guyanese.

“We continue to promote advanced healthcare via NeuroSpince Services Inc., and our partners internationally, so Guyanese no longer have to go look for a flight to go overseas to have these procedures done,” Dr Dukhi said.