A pediatric neurosurgeon said surgery on Brian Lankuts was adequate and appropriate as planned and carried out, but he would not have done the same operation, the ACT Coroners Court yesterday (thurs17sept).
Dr Robert Jones, of the Prince of Wales Hospital in Sydney, was called as an expert by Stuart Littlemore, for neurosurgeon Dr Nadana Chandran, maxillary facial and oral surgeon Dr Peter Vickers and plastic and reconstructive surgeon Dr Alan Ferguson. He was giving evidence into the inquest into Brian Lankuts, who died aged five months on November 21, 1990, after surgery to correct a skull abnormality which threatened to compress his brain.
Dr Jones disagreed with an earlier expert, Dr David David, head of the Australian Cranio-Facial Unit in Adelaide.
He disagreed with Dr David’s conclusion that all three of the three major sutures (gaps) in Brian’s skull had prematurely fused and that they needed correcting in two fairly closely staged operations involving both front and back parts of the skull.
He said only two sutures were fused. He thought the timing of the operation was about right. He would have done an operation within perhaps a month of seeing the child. He would have operated on the back part of the skull, not the face or the forehead, and the aim would have been to provide enough room for the brain to grow. In Brian’s case, he thought, cosmetic matters could have been rectified, if necessary, much later. He did not think there was significant facial abnormality to warrant facial surgery at that stage.
He thought the operation’s timing and planning were right.
In response to counsel assisting, Steve Loomes, Dr Jones said he would have done the operation in two stages. He would have to criticise the surgeons on this score. This would have cut the need for blood transfusion. Asked whether he would have done the operation Dr Chandran had done he said: “”No I would not have done this particular procedure.”
He would, however, not have done it in the way Dr David suggested. He would have concentrated on expanding the vault by “”strip cranioectomy” (cutting strips from the skull bones). He would have done one side first, then the other side three to six weeks later.
“”It does have other risks and it is more fiddly,” he said.
Mr Littlemore asked him whether such a fatality could have happened to him. Dr Jones said it had nearly happened a couple of weeks ago. The baby had lost a lot of blood and he had had to control high potassium levels.
Mr Loomes asked: “”Did you save that baby?”
Dr Jones said he had. After the anaesthetist had signalled a problem for the second time, he had stopped the operation and put the bones back.
He agreed with Paddy Bergin, for anaesthetists Dr Nicholas Gammell-Smith and Dr Raymond Cooke, that if it had required the same time to finish as go back to the original position he would have finished, but that would not usually be the case.
He disagreed with Dr David’s view that such surgery should be done in one centre in Australia because of the disruption to families with travel and accommodation.
He thought enough x-rays and scans had been done; to do more would have unnecessarily increased Brian’s exposure to radiation.
He disagreed with a report from Dr R. J. Allen, of Woden Valley Hospital that the third major skull suture (the coronal) was partly fused.
A report by Dr Robert Sweeney, of the Adelaide Children’s Hospital said there were no omissions in monitoring, but it was difficult to interpret the anaesthetic record. This often happened in stressful situations when the patient was being concentrated upon.
He thought there had been inadequate early blood replacement. It was very easy to get behind with blood replacement and this had happened in this case.
There had been no fluid balance chart with a time scale in the theatre or in intensive care.
Dr Sweeney has not been called for cross-examination on his report.
Dr Jones agreed with the procedure adopted by Dr Gammell-Smith that when Brian’s blood pressure dropped to treat it as blood loss, even if other indicators did not show blood loss _ what Ms Bergin called a paradox of readings.
The inquest will continue today, .