Three Surgeries, One Happy Family

Marilis Byrnes and son Liam's Story

Marilis Byrnes and son Liam

Today Marilis Byrnes and her 1-year-old son, Liam, are having a pretty typical mom-toddler experience: thriving, happy and occasionally covered in oatmeal. But it wasn’t always clear that would be the case. Getting there took three surgeries: a spine surgery for Marilis, by neurosurgeon Dr. Christopher Mandigo, and spine surgery followed by brain surgery for Liam, by pediatric neurosurgeon Dr. Richard Anderson.

Marilis’s troubles began with some mild numbness in her hands and feet while she was pregnant with Liam. Marilis wasn’t too concerned. But then things took an alarming turn: The numbness spread to her arms and legs. She started falling. Soon she decided it would be safer to use a wheelchair. By that point, Marilis was scared. “I didn’t know what was going on. I was just losing feeling, everything was getting worse. I thought, ‘When this baby is born, I won’t be able to hold him. And I won’t be able to care for my 4-year-old daughter either’… It was pretty scary.”

Her doctors were about to get very concerned too. Prenatal testing had indicated that the baby she was carrying had a developmental condition called spina bifida, in which the spinal canal does not close normally in the first few weeks of gestation. Because of the spina bifida, Marilis was seeing high-risk pregnancy specialists at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital. When Marilis came to an appointment in a wheelchair, those specialists checked her into the hospital so they could figure out what was going on.

Soon, an MRI of her neck identified a problem unrelated to her pregnancy: severe compression of her spinal cord.

Marilis happens to be a neurology nurse, so she knew some things from the start. She knew that compression of the spinal cord can block it from transmitting sensation or movement, causing numbness or paralysis. And she knew that such compression has the potential to cause permanent, irreversible damage.

But Marilis’s medical experience meant that she knew something good too: When she met Dr. Mandigo, Marilis says, “I knew right away that he was the man.”

Dr. Mandigo happened to be the neurosurgeon on call when Marilis checked into the hospital. “I’m so grateful for that,” she says. From the moment he came into her hospital room, “I felt comfortable having him take care of me.” He had the gargantuan task of explaining to Marilis, her husband and her parents that in order to safeguard her spinal cord, Marilis would need spine surgery right away—while 28 weeks into a high-risk pregnancy. His hope was that permanent damage to her spinal cord had not occurred, and that she would make a full recovery of movement and sensation.

That’s a lot for any patient and her family to take in. But Marilis clearly remembers Dr. Mandigo’s manner during that conversation: “He was very comforting… so kind to me and my family.”

Dr. Mandigo has experience operating on pregnant patients, so he was able to speak from knowledge and experience to Marilis’s biggest concern: the baby. “He reassured me about what was going to happen with the baby. He told me they were going to have someone from OB there monitoring, and that I was going to get steroid shots to help with the baby’s lungs just in case he had to deliver.”

Dr. Mandigo also fully explained the spinal portion of Marilis’s surgery, which itself would be complex. He would go in through the front of her throat and remove some discs—the spongy cushions between the bones of the spine—that were damaged and compressing the spinal cord. He would enlarge the bony channels through which the spinal nerves branch out from the spinal cord. And he would remove one entire vertebra (bone of the spine) that had severe stenosis (narrowing). He would replace the vertebra and discs with surgical hardware and a bone graft, fixing them in place so that the spinal cord was no longer compressed. Throughout the operation, he would use monitoring technology to protect the function of Marilis’s spinal cord. The expert OB surgeon would also be there monitoring the baby during surgery.

Surgery began the very next morning, and seven hours later the spine surgery was finished. Mom and baby came through with flying colors. Marilis’s spinal cord had not sustained any permanent damage, and the feeling in her hands and feet had already returned when she woke up. And more great news: the baby did not have to be delivered early; he was able to continue developing in utero.

Marilis spent three days in surgical recovery, then three more days in Labor & Delivery to continue monitoring the baby. While in the hospital, Marilis started physical therapy to work on her strength and balance. She began walking again, first with a walker, then a cane. In less than eight weeks, she was out of the wheelchair and walking independently.

Marilis returned to work. She worked for two weeks and then the big day arrived: Liam’s birth day. Marilis travelled from her home in Westchester down to Columbia for her scheduled C-section. Because of her own recent surgery, Marilis needed some special care–care that her expert team was prepared for and easily able to provide. After the bumpy journey of the last few months, finally, beautiful baby Liam was born!

But there was still one more spine surgery to go. Like his mom only months before, baby Liam also needed surgery—yet the doctors knew about his, so it had been planned for quite some time. It was due to a rare form of spina bifida called myelomeningocele. In this condition, the membranes, bones and skin around the developing spinal cord do not close as needed. Myelomeningocele is treated with surgery to enclose the spinal cord within the first hours or days after a baby is born.

Columbia pediatric neurosurgeon Dr. Anderson is an expert in myelomeningocele, and he had been consulting with Marilis and her husband since Liam’s condition had been discovered. Four hours after Liam was born, Dr. Anderson performed surgery to close the opening in his lower back.

This was a scary time for Marilis and her family, but they were comforted by Dr. Anderson’s boundless compassion and expertise. “I want people to know that Dr. Anderson is phenomenal,” says Marilis. “He is so caring, and his staff is amazing. If I had other babies, I’d have him do all surgeries [not just neurosurgery].”

Don’t get any ideas, folks—Dr. Anderson is going to stick with pediatric neurosurgery. But he does treat more than spine conditions.

When Liam was almost 6 months old, Dr. Anderson performed the surgery to treat Liam’s hydrocephalus, or “water on the brain”—a condition that commonly occurs with myelomeningocele.The most common treatment for hydrocephalus is a shunt, or tube, that drains the excess fluid from the brain. Shunts are effective in treating hydrocephalus, but they do come with some risks of complications over the course of a lifetime.

To avoid these risks, Dr. Anderson was able to perform a different procedure, called an endoscopic third ventriculostomy (ETV) with choroid plexus cauterization. This procedure is available at very few centers, as it is most effective when performed by a surgeon who is experienced with the procedure and who has access to specialized equipment. Luckily for Liam, Dr. Anderson fits the bill in both cases. Liam’s ETV and choroid plexus cauterization went extremely well. His hydrocephalus cleared up and will no longer be an issue for him.

Today, the Byrnes household is busy, and that’s a great thing. Marilis is back to work, and she believes that her experience has made her a better nurse, both clinically and empathetically. Liam is busy being a young toddler, full of life and coated with whatever happens to be in his bowl at the time. He crawls well, and with physical therapy he is making great progress on standing and walking. Marilis is not only walking, but running—literally, with a preschooler and a toddler to chase after. “For them, it’s like nothing ever happened,” she says with a smile. “Mommy is back to normal.”

Read more about Dr. Mandigo on his bio page here.

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