Neurosurgery Across Borders

Posted on Aug 23, 2017

George Jallo, M.D. receives a kiss as thanks from Raphael for removing a tumor from the Brazilian boy's spinal cord.

Rafael Furtado is a chatty, happy 5-year-old boy living in Porto Alegre, Brazil. He is making friends in nursery school and learning English in addition to his native Portuguese.

It is a picture that his mother, Marlucia, and anesthesiologist father, Ricardo, would have found difficult to envision a year ago but for Johns Hopkins All Children's Hospital stepping in to help.  Johns Hopkins All Children’s has been building relationships with hospitals and medical professionals overseas to benefit children all over the world. The hospital’s location in St. Petersburg, Fla., makes it a valuable asset to Latin America.

Premature, with neurological issues

Rafael was born prematurely at 27 weeks and as a consequence developed brain damage and a buildup of fluid in the brain known as hydrocephalus. When Rafael turned 4, a routine MRI revealed a tumor in a complicated location of his spinal cord. Its removal would require extraordinary surgical expertise. None of the neurological surgeons in Brazil familiar with the case would attempt the procedure.

But one of them, Gustavo Isolan, M.D., who did a fellowship at the University of Arkansas, had met George Jallo, M.D., director of the Johns Hopkins All Children’s Institute for Brain Protection Sciences. An internationally respected pediatric neurosurgeon, Jallo joined the hospital in September 2015 after more than a decade at Johns Hopkins University and The Johns Hopkins Hospital in Baltimore, Md., where he was the head of the Division of Pediatric Neurosurgery.

Compassionate care

Jallo initially consulted with the Furtado family over Facetime. Once he determined the surgery was within the realm of his expertise, he went in May 2016 to Porto Alegre, accompanied by Joana Machry, M.D., a neonatologist at Johns Hopkins All Children’s and a native of Brazil. Members of the Furtado family greeted him at the airport. Previously, Machry had traveled in the region to the Hospital Moinhos de Vento, a Johns Hopkins affiliate, assisting it with improving medical and nursing protocols at its neonatal ICUs.

He removed the tumor at Hospital Moinhos de Vento. Post-surgery examinations reveal no trace or recurrence.

"Our apprehension melted away when Dr. Jallo got involved,” Ricardo Furtado says with Machry acting as translator. "We had familiarity with Johns Hopkins, well-known among medical practitioners throughout the world. We were euphoric when Dr. Jallo accepted Rafael's case. We knew he was in good hands.

Crossing borders

Jallo says Rafael's condition is very rare. Performing surgery in Brazil was a first for Johns Hopkins All Children’s.
Preparation was thorough and included Jallo videoconferencing with the Furtados before the surgery. Ricardo Furtado observed that his son's prospective surgeon "was very human and compassionate. We felt comfortable. There were no barriers, no reservations."
Because of his medical training, Furtado knew neurosurgery can take several hours but was relieved when Jallo and the team seemed calm and comfortable as they completed the operation in just two hours. 
"This gave us confidence,” Furtado says.
And Rafael?  He is walking more and at longer distances.  His vocabulary has increased considerably and his interaction with others has blossomed, according to his parents. Rafael was due for another MRI in June to ensure that everything is OK.
Johns Hopkins All Children’s Hospital works closely with pediatric specialists in neuro-oncology, neuroradiology, neuropsychiatry, behavioral medicine and neuropathology. The hospital also offers a full range of pediatric subspecialty care. Experienced pediatric neurosurgeons work with a team of skilled physician assistants, nurse practitioners, nurses and technologists to provide comprehensive care before, during and after hospitalization. For more information, click Institute for Brain Protection Services. Visit to read the complete Summer, 2017 issue of Leading Care magazine, where this story first appeared.

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