Palliative surgery in a patient diagnosed with trisomy 18 and rare neurological comorbidities

Abstract

Introduction: The authors describe a case of a patient with a prenatal diagnosis of Trisomy 18 with atypical manifestation, rare anomalies of the central nervous system and subsequent surgical treatment. Case presentation: The infant was diagnosed with holoprosencephalia, schizencephalia, corpus callosum agenesis and severe hydrocephalus. No significant heart, gastrointestinal or kidney defects were found. Being in otherwise good condition, the patient was qualified for a ventriculi-peritoneal shunt surgery due to rapidly increasing head circumference. Following the uneventful operation patient’s parents reported a general improvement in their child condition. Conclusions: Bearing in mind the possibility of complications and the child’s poor prognosis, the reasons for surgical intervention were evaluated, as well as the possible outcomes of withholding invasive treatment. Discussion over the benefits of palliative surgery and the risk of ‘palliative harm’ illustrate how selected children benefit from an interventionist approach.