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New surgery technique relieves pain for myelomeningocele patients

Mark Mittler, MD, and Paul and Adryana Navarro
Mark Mittler, MD, and Paul and Adryana Navarro

Born with the severe form of spina bifida, Paul and Adryana Navarro are living free of pain and headaches after having ventriculoperitoneal shunting.


Thanks to a groundbreaking surgical technique performed by the pediatric neurosurgeons at Cohen Children’s Medical Center, Paul Navarro, 15, and his 8-year-old sister Adryana, can finally anticipate a Christmas holiday free of the pain and headaches caused by the shunts placed in their brains since birth.

The brave youngsters were both born with myelomeningocele (MMC), a severe form of spina bifida in which the fetus’ spinal cord fails to close during development. Mark Mittler, MD, co-director, division of pediatric neurosurgery at Cohen Children’s, has been caring for the Navarro siblings since their birth. In both cases, he was there at the time of their delivery and repaired the MMC. Each of them, as expected, developed hydrocephalus (a dangerous buildup of fluid in the cavities (ventricles) deep within the brain.

During a recent reunion at the hospital with the youngsters and their relieved parents, Dr. Mittler explained the siblings’ condition. “The excess fluid increases the size of the ventricles and puts pressure on the brain,” he said. “To treat this condition, both Paul and Adryana underwent ventriculoperitoneal shunting after the MMC closure.”

The procedure involved placing a tube from the ventricles (spaces) of the brain into the abdomen three days after their births. Shunting has been the primary treatment for hydrocephalus for nearly 100 years, according to Dr. Mittler. But complications are common. Paul has undergone 69 surgeries for necessary repairs to his shunt since birth while Adryana has undergone 19 surgeries for the same reason.

quotation mark Cohen has given us the best Christmas present ever. Our children truly are warriors, and now, they’ll be able to enjoy the lives we want them to have. We will always be grateful.
Karen Navarro

“This is considered typical when shunts are used in children so young,” said Dr. Mittler. “But the problem is that shunts are plumbing, and as we all know, plumbing often fails.”

During an emotional conversation during which both youngsters tried to hold back tears, Paul admitted, “It’s been a real struggle to have shunts and struggle with complications throughout the years. We’ve spent so many holidays in the hospital, and now, not to have to worry about heading to the emergency department on Christmas Day – it’s really wonderful.”

The reason for the change is the progressive thinking of Dr. Mittler and his colleagues. Earlier this year, they were able to convert the children’s shunts to a more natural approach as a way to treat their hydrocephalus.

“In each case, a camera was navigated through the spaces of their brains to drill a hole at the base,” said Dr. Mittler. “This provided a new, fluid pathway for the drainage of excess fluid.”

Paul’s shunt was removed during the summer; Adryana’s was removed earlier this year. Both youngsters report being headache-free, and, as Paul said, “I used to be able to feel the shunt through my neck. I don’t have that sensation anymore.”

Calling them her heroes, Karen Navarro, the siblings’ mother, said, “This will certainly be a very special Christmas for all of us. Both of them have always been happy and positive, always looking forward to having a normal life.

“Cohen has given us the best Christmas present ever. Our children truly are warriors, and now, they’ll be able to enjoy the lives we want them to have. We will always be grateful.”