Featured Article - Miracle Neurosurgery

Although the MCG Children's Medical Center's neurosurgery specialists perform many successful operations every day, few successes are as awe provoking and rare as two produced in the last few months. With Dr. Mark Lee, chief of pediatric neurosurgery, at the helm, the CMC's team of neurosurgeons and support staff provide quality, progressive care for children of Georgia, South Carolina and surrounding areas with a wide range of neurological issues including epilepsy, disorders of the pituitary gland and brain tumors. Many hospitals offer care for children with these problems, but Dr. Lee's team is unique to the region, and even the nation, for their aggressive approach in a number of neurological disorders and the comprehensive care they provide. The two recent successful procedures performed by Dr. Lee and his staff, radical resection of a cervicomedullary tumor and a hemispherectomy on a 31û2 year old with Rasmussen's encephalitis, are procedures that most medical centers and neurosurgeons are unable or unwilling to perform.

After a six-year old boy's attentive gym teacher noticed he was becoming increasingly clumsy, his mother, an ICU nurse, insisted their pediatrician order an MRI scan. The test revealed a low-grade pilocytic astrocytoma, a generally benign tumor, extending inside the brain stem and spinal cord to the third cervical spine. Although radical resection of this type of tumor has a cure rate of 95 percent, the standard treatment of care is partial resection with radiotherapy for fear of surgical morbidity. Having trained under Dr. Fred J. Epstein, one of the pioneers of radical resection of these tumors, Dr. Lee was confident in his skills and encouraged an aggressive approach. The boy and his family learned that without any treatment, the tumor would continue to grow, and eventually result in death. They also learned that while partial resection would reduce the size of the tumor and radiation would reduce it even more, any portion of the tumor left after treatment would continue to grow and the boy would most likely never live a normal, full life. Complete resection, Dr. Lee believed, was the only option that would ensure the tumor was removed in its entirety and, if successful, grant the boy the chance to live a completely tumor-free, healthy life. Despite the risks of radical resection, including the worst case scenario of post-operative life-support (5 percent) and a more likely temporary functioning incapacitation (50 percent), the family decided that the prospect of a normal full life with surgery was a chance they had to give their son, so they put his future in the very capable hands of Dr. Lee.

During the eight-hour surgery, Dr. Lee tunneled his way to the tumor via a window in the skull and carefully identified and removed every bit of tumor tissue from the spinal cord and brain stem.

Before Surgery
 
After Surgery

Within two days after the surgery, the boy could stand and begin walking. When it was time for the boy to return home, he had recovered such that he literally ran out of the hospital. Six weeks later, the boy recovered almost 100 percent. With a flawless record, Dr. Lee has performed this surgery at MCG between eight and 10 times and is one of the nation's very few specialists willing and able to do the procedure.

The second novel and aggressive procedure that Dr. Lee and his team perform, a hemispherectomy, is also not one of its kind at MCG. Many are surprised to learn that Southeast Georgia has a competent team of neurosurgeons performing successful hemispherectomies, and that MCG specialists have performed more than 20 in the last few years. Recently, Dr. Lee was presented with a candidate for this procedure: a 31û2 year-old girl with suspected Rasmussen's encephalitis. While the exact cause of this disease is not known, its course and outcome are known all too well.

Affecting an entire hemisphere of the brain, Rasmussen's causes numerous seizures all day, every day until the hemisphere burns out. The constant seizures affect normal functioning, speech and motor skills; they also affect the healthy hemisphere of the brain, eventually reducing cognitive ability. The conventional standard of care for this disorder is allowing the diseased hemisphere to burn itself out and then perform the hemispherectomy. This is done because common belief is that transfer of function does not occur until burnout is complete and also because at that point, Rasmussen's is definitively confirmed. Dr. Lee takes a different approach, however, by surgically intervening earlier and not allowing the healthy side of the brain to be affected. His belief is that transfer of function occurs much earlier before the diseased hemisphere burns out, and by performing a hemispherectomy sooner, the healthy hemisphere is granted relief from the seizing side and the loss of cognitive function is limited.

Certainly choosing a hemispherectomy for a 31û2 year-old is not an easy one, but Dr. Lee and the girl's parents felt the benefits of performing the surgery at an early stage of the disorder outweighed the alternative and associated risks. The parents and Dr. Lee wanted to give girl the best chance to live a normal life with an average IQ. A biopsy of the girl's affected hemisphere confirmed Rasmussen's, so Dr. Lee and his team proceeded by removing most of the hemisphere and leaving frontal and occipital poles. The poles, the corpus callosum and any other remaining portions of the diseased hemisphere were disconnected from the healthy side allowing it to remain unaffected.

Following the hemispherectomy, the girl had paralysis of her left side, but the thousands of daily seizures had stopped. Six to eight weeks after surgery, the girl was able to stand and begin walking. Two months following surgery, she could walk with a limp and began using her left arm. She will eventually be able to run and do most things children her age do, and most importantly, she will be able to understand and appreciate doing them.

While these two stories are amazing, they are not the only ones. Dr. Lee and his team have performed other novel surgeries such as stereotactic endoscopic fenestration of an arachnoid cyst. With the technical capabilities and a dedicated, talented staff, the section of neurosurgery is accomplishing surgical feats daily and is a invaluable component of MCG HealthCare's Neuroscience Center. The center is the only comprehensive program in the area treating adults and children with second-to-none programs and services for patients with common, rare and difficult-to-treat brain, spine and nerve disorders.