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         Disarming the Bomb In
         Hunter's Head & Other Tales
         of the King of Pediatric Neurosurgery

roughly 80 percent of adult neurosurg-          AI. Noticing that the CD has ended, he       they still have minds, brains...
"There's nothing more devastating
interned at University Hospitals, recom-             Though he retired from neurosurgery
mended Rainbow.          For this...
In the era of cybersurgery, neurosur-                                  images from a CAT scan or MRI into a
geons have tak...
Come see what's brewin'
                                                  bomb has been defused. For now. One             ...
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DISARMING THE BOMB IN HUNTER'S HEAD & Other Tales of the King of Pediatric Neurosurgery


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Christopher Johnston wrote this article for Northern Ohio Live, where it was published in September 1999.

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DISARMING THE BOMB IN HUNTER'S HEAD & Other Tales of the King of Pediatric Neurosurgery

  1. 1. • Disarming the Bomb In Hunter's Head & Other Tales of the King of Pediatric Neurosurgery By CHRISTOPHER JOHNSTON Fortunately, the tiny bomb lurking in Hunter Severns' head has not escaped detection. Diagnostic scans on two light screens on the operating room wall reveal its shadowy outlines insinuating throughout his brain, stealing blood from its rightful recipients. It's bruit (pron. "brewy"), or whooshing sound from the fast-rushing fluid, rumbles through a stethoscope pressed to his shaved scalp. His bomb has a medical name: arteri- ovenous fistula (AVF) or vascular mal- formation. In plain English, this knot of errant veins and arteries threatens to explode into seizures or a stroke. Upon detonation, the well-concealed mind mine would probably prohibit Hunter from growing beyond his three and a half years. Today, though, the Danville, Ohio, boy has entered. the realm of Big Al Cohen, King of Pediatric Neurosurgery: pressure of working in complete silence "Our goal today is to reduce the flow OR #28 at Rainbow Babies and and tension erupting into the angry in this fistula," Big AI explains. "We Childrens Hospital. Dr. Cohen will be exchanges he often witnessed in his resi- probably won't be able to completely directing the day-long drama about to dency years in New York and Boston. eliminate it, but we're going to cut it unfold, orchestrating the intricate dance It's now 9:00 am. Fully anesthetized, down significantly. The risk is that he of an elite squad of neurosurgeons, nurs- Hunter's bald pate is elevated from the can bleed explosively again, but it's a es, anesthesiologists and neuroradiologists. table, pinned into a graphite head-holder controlled situation, so we're giving him The music? that is radiolucent, which means it will this one shot." "You need the King for tough surg- allow X-rays to pass through should the Hunter has many things going for eries," Big AI says,referring not to him- surgeons need to check their progress him today, including the fact that the r+'__ The arcing baseball pediatric brain is more resilient than the .,.;s:,;;e~lf:>~b:;:..u';;;,t:c..,;;:.,.;t;,;.h;,:;e~se~l~e.:::c~ti:.:::o:.:;n~s...:fi;;;;r;;:;o~m~E~1:.;v~is;:..'_..;,W1.:;.;·;;:;th~a~n~angiog!"am. Platinum Collection CD, a gift from the stitch in his scalp reveals an angry rem- adult brain. nurses, blaring from a boombox in the nant of an operation performed by Dr. "In pediatric neurosurgery, we deal corner. Cohen when Hunter was just two with the evolving child, so it's a chance "The whole OR works better if weeks old to staunch a nearly fatal hem- to have a profound effect on someone's everybody's relaxed," he adds, outlining orrhage. The doctors knew then they entire life," Big AI says later. He also his theory of different music for different would have to revisit the "big pipe-like enjoys the opportunity to confront a stages of the operation. Brain surgery is feeding vessels," five times their normal whole spectrum of neurosurgerical prob- tense enough without the additional size, at a later date. lems in the pediatric brain, whereas 133
  2. 2. roughly 80 percent of adult neurosurg- AI. Noticing that the CD has ended, he they still have minds, brains, spines, eries are spinal operations. calls for the circulating nurse. "Kathy? nerves that function healthily after As the team swirls around the child, What's missing from this room?" She tumors, vascular malformations, covering every inch of his naked body pops in a Vince Gill CD from the pile aneurysms and other foreign invaders with blue, sterile surgical drapes, includ- on the speaker marked "To Be Played." were repelled by Cohen and his Court, ing several stapled to his scalp to reduce The procedure is about one quarter the hospital's medical staff. the risk of infection in the soon-to-be complete. Many hours will be spent In his office, Big Al's majestic desig- wide-open head, Hunter lies quietly, slowly dissecting Hunter's brain to reach nation residesin the crayoned thank-you vulnerable, trusting in the sweet brutality the torturous tangle of veins and arteries notes framed on his walls, including one of late 20th-century medical science to so they can be clamped off. from a lS-year-old girl grateful for his save his life - and all of his neurological "It takes an hour for us to move a removing the bullet from her frontal functions, personality, emotions. First, millimeter here, but that's the way it lobe after she lost big at Russian roulette. they must first sever, drill and saw off a works in the brain," Dr. Cohen says.No Or the letter from the 9-year-old subject third of his skull. one expected the job to be easy. After who, thinking her King should have an Due to the complexity of the opera- all, this IS brain surgery. autographed Jay Leno head shot to tion, two senior residents will assist. At The doctor who would be King, counteract the "dorky Pat Sajak" picture 9:S5, under Dr. Cohen's watchful guid- Alan R. Cohen, MD, FACS, FAAP, in his office, wrote The Tonight Show ance, doctors Christopher Taylor and chief of pediatric neurosurgery, host. Leno agreed. Skekar Kurpad initiate the craniotomy University Hospitals Health System, The true seat of his kingly powers, that will expose the pulsing, bloodied Rainbow Babies & Childrens Hospital, however, arises from the regal, pink gray peaks and valleys of Hunter's acquired his honorary title through the Elvis-in-Full-Vegas lamp on his desk. abnormal brain. "Fish hooks" attached power vested in him by his loyal sub- And the black velvet Elvis painting on to his scalp hold back the loose flap of jects: patients newborn to age 18. In his wall. And the Elvis doll on his book- skin. As they begin to drill burr holes their minds he is King solely because shelf Etceteras. Actually Big AI, who's through his skull at points drawn in pur- ple marker, a faint whiff redolent of the dentist's drill entering enamel hits the air. Bright red blood drips into the plastic irrigation bag attached to Hunter's head to keep fluids from lubricating the floor. The team displays an easy cama- raderie, joking about the competition between the two senior residents. Dr. Cohen deadpans that they are prima donnas comparable to Major League i l Baseball pitchers Roger Clemens and David Wells. Dr. Taylor counters that they drew short straws the night before to determine who would have to work with Big AI. "We spend years of training and practice, and everyone here is highly skilled, so when we're doing a standard opening, it's like changing a carburetor," Big Al offers. "So we can be a little more relaxed." Things get tense fairly quickly, how- ever, as they penetrate the leather-like protective lining of the brain, the dura mater, literally "hard mother" or collo- quially "tough bitch," and at 10:29 one of the vesselsstuck to the lining ruptures, spouting blood several inches into the air. Using bi-polar forceps to cauterize the vessel, they work quickly to get the bleeder under control. "That was impressive," assessesBig
  3. 3. "There's nothing more devastating than losing a child," he says."When you have a child with a brain tumor, the whole familyjust fallsapart." • Thus, the Elvis paraphernalia and the lS0-pound fish tank become imbued with a loftier purpose. "These objects sort of diffuse things, especially for the parents," saysBig Al. DAVID ROBINSON TREASURES his first expo- sure to Big Al's own private Graceland, just a few days after his surgery. "They wheeled me into his office before I went home, and I still couldn't think straight," he recalls. "I saw the Elvis lamp and all this Elvis stuff, and I didn't know if it was just me that was weird or if it was Al." David's father, Michael, laughs when he remembers his first audience with the King, too. Though he wasn't laughing on that hot May night in 1997, as the Akron attorney tried to wrap his own mind around the word "ganglioglioneu- rocytoma," a tumor that had felled his 17-year-old son, who just 12 hours ear- 47, admits, "I'm not that crazy about the while doing a residency at Bellevue lier awoke a perfectly healthy kid, except King," but someone gave him the lamp Hospital in New York, he studied with for a headache. as a gag gift and a pediatric legend was Tony Slydini, a septuagenarian Italian The Bath, Ohio, Robinson family born. The kids figured if their man likes magician. Until he got too busy, Cohen had ventured to Athens to visit Ohio the King of Rock, then, hey, why not used to unicycle into the kids' ward and University, where David was headed in crown him the King of Pediatric entertain them with tricks. the fall. During the day, he had grown Neurosurgery? Not every operation ends with a increasingly ill, to the point where he Actually, Big Al's not that big, either. miraculous vanishing disorder, though. couldn't hold a cold can of pop his But his well-defined hands seem too On the bulletin boards laden with snap- father offered, thinking his son had the large for his average stature. The hands shots sent to him by his subjectsand their flu from which his brother and step- of a surgeon. The hands of a magician. families,Big Al can point out a few with mother had just recovered. A frantic trip Sure, magician works metaphorically for malignant tumors who never had a to a Parkersburg, West Virginia, hospital this story, but the man is actually trained chance or died severalyears after he oper- ensued. There, after reviewing a CAT in slight of hand. Seeking a diversion ated from a recurrence of their cancer. scan, the neurosurgeon, who had Imagine how professionally Sponsored by designed and installed • Alzheimer's Awareness Week 1999 We're painting the town purple beginning September 26! ~ landscaping can enhance • Memory Walk-Run your home. "Get on Your Feet" at the Cleveland Metroparks Zoo on October 3 or the satellite walk at Lake Erie College in Painesville on October 9! During the week of September 26 through October 3, the Alzheimer's I DMfi.5TER! Association will sponsor these and other exciting community events. AL·ZjEIMER'S® LANDSCAPE ARCHITECTS & CONTRACTORS 440-951-9100 For further information, please call: 216-721-8457 ASSOCIATION or 800-441-3322 Someone to Stand by You 136 NorthernOhioLive ; September 1999
  4. 4. interned at University Hospitals, recom- Though he retired from neurosurgery mended Rainbow. For this particular last year after 38 years behind the scalpel, disorder, the Robinsons' family doctor Dr. White continues to teach at Case also endorsed Rainbow. Western Reserve University's medical Still, after his son was life-flighted to school and travel the world lecturing on UH and he raced at 100 mph to "the most magnificent structure ever Cleveland, Michael Robinson was not created." Through the Brain Research convinced. Then the friendly doctor Laboratories he established at CWRU who happened to be on call that night and Metro General Hospital in the early also recommended Rainbow to remove '60s, Dr. White's research team became the rare tumor, which had somehow the first to isolate the brain in a monkey, grown to the size of a softball without removing it and keeping it alive with any symptoms and was hemorrhaging. machines, then later transplanting the "It's kind of comical now," Michael monkey's brain. Their National chuckles. "I was standing there talking to Institutes of Health-funded work also the best doctor I could find, but I'm pioneered cooling techniques to thinking he's just some guy they sent in enhance brain surgery procedures and on Saturday night who doesn't know limit injuries in stroke and head-trauma anything, and I want my kid out of patients. there." He knew he was talking to a Dr. Although Dr. White believes his Cohen, but he didn't know until 12 chosen field has benefited from advances hours later that he was dealing with the in anesthetics, optics and radiology, he's King of Pediatric Neurosurgery. less optimistic about progressions in neu- "Everyone wants to think they've rosurgery itself For instance, one of the accomplished something by going to the brain's most primal adversaries, malig- Mayo Clinic, but we couldn't have nant cancer, remains a vexing challenge. ended up with anybody better, no matter "If I were going to operate on a where we would have gone," he contin- malignant tumor, I don't think I could ues. "Al has just been an all-around nice do any better job today than I could guy since then. He never just passed us have done 30 years ago," he says. off to other people in his department, Nevertheless, Dr. White rates and he stays in touch with us." Cleveland a good place to seek neuro- "Big Al's an awesome guy," claims surgical succor. Referring to the popular David, who recovered so quickly he was but flawed annual rankings of health- able to attend his senior prom and grad- care institutions in U.S. News & World uation just a few weeks later. After a Report, Dr. White says, "We have been rough freshman year, recovering emo- improperly rated as a neurosurgical com- tionally from his experience, he has gone plex. The Mayo Clinic is at the top, and on to earn a 3.3 GPA at OU, where he it's hard to beat all of the resources of performs with the marching band. New York, Chicago, Boston or Los "There's really nothing I can't do now," Angeles, but I would say overall, with he says. He has an MRI every six the Cleveland Clinic, University months to ensure his ongoing health. . Hospitals and MetroHealth System, So, in one cerebral hemisphere, we're 9th or 10th in the country." President Bush, who labeled the '90s the As we round out the Decade of the Decade of the Brain, would be pleased Brain, our King of Pediatric to know great strides have been made in Neurosurgery, whom Dr. White ranks as mitigating certain life-threatening, neu- "excellent," is proactively pursuing rological disorders. In the other hemi- advances in neuroendoscopic surgery or sphere, though, essential advances appear minimally invasive techniques to treat out of sight, far into the next century. some tumors and hydrocephalus, water "We know less about the brain than on the brain, the most common pediatric we think we do," posits Cleveland's neurosurgical problem. The intent is to dean of neurosurgery, Robert J. White, replace the severely invasive craniotomy M.D., Ph.D. "It's hard to give it a per- procedure whenever possible and allow centage, but we only know a fraction of the patient to go home the next day with the brain's capabilities." "just a Band-Aid on their head."
  5. 5. In the era of cybersurgery, neurosur- images from a CAT scan or MRI into a geons have taken the endoscope, a small three-dimensional plane, enabling sur- tube employed for laproscopic proce- geons to place their instruments with less dures to remove gall bladders without than a millimeter accuracy to reach any exenterating the abdomen, and modified place in the brain safely. it to enter the skull through a dime-sized In early October, Big AI will once opening. A fiberoptic camera projects again lead a course sanctioned by the onto a TV screen, allowing surgeons to American Association of Neurological maneuver inside the head with miniatur- Surgeons in these video-centered proce- ized lasers, grasping forceps, scissors, etc. dures he refers to as "Nintendo neuro- This approach also relies on stereotactic surgery." Picture a group of some of the seed to test their eye-hand coordina- surgery, a computer-guidance system finest neurosurgeons in the world hun- tion with the endoscopic instru- which translates the two-dimensional kered over pumpkins, trying to extract a ments before moving on to cadavers. "We teach that the goal of the Join the light surgeon is to follow the bank rob- ber's credo: Get in without anybody against breast cancer. Annual knowing about it, get the money, get out," Big AI quips. Ever the optimist, Big Al cites The Susan G. Komen ~ B=" Cancer 1C1 advances that have resulted in curing ailments fatal just a decade ago. Hunter's case, for example, a disor- der that accounts for less than one o OR percent of pediatric neurological pro- cedures, became treatable in the '90s. One of the advances making that HE possible is the ability to perform both neuroradiological therapies as z Presented by JCPenney ORE well as intraoperative diagnosis. In other words, as in Hunter's case, a team of neuroradiologists first spent dA. ~'~'-f>I-~ ~ 12 hours the day before his surgery J'I1 newbolonce .;:;... ~ -P;~I ""1l'I!' .I~ I!t.!lI ~ inserting tiny coils through a catheter in his thigh to occlude or Sunday, September 28, 1999 close as much of the vascular mal- Hotline: 216.791.CURE (2873) wade OVal at University Circle formation as they could reach. Then Cleveland, OH during his surgery, they brought in Website: 8:30 am 5K Men's Competitive Run a portable angiogram machine sev- 9:15 am Coed 1 Mile Fun Walk E-Mail: eral times to provide new scans that 9:45 am Coed 5K RaceNl/alk would tell the surgical team how successful their efforts were in clos- ing the remaining aberrant vessels. In fact, at 5:15 that Friday, An Atmosphere That Brings though everyone is tired and itching to close, Dr. Cohen requests a Out The Best in Students fourth angiogram. "If we've really occluded the malformation, then Just one reason families choose Lake Ridge Academy we're done, and Hunter won't need We offer a quality college preparatory education to young men and women in kindergarten through grade to get a post-operative angiogram twelve. and go through the general anesthe- If you're looking for personalized attention, a warm, sia again," he says. "Anything that's caring, environment and high academic standards, still there, we're going to clip, then consider Lake Ridge Academy. get out.. .. I just feel obliged to take For further information, please call or write Lake Ridge one more look." Academy at 37501 Center Ridge Road, North Ridgeville, Ohio 44039, (440) 327-1175 or (440) 777-9434. The angiogram confirms that the ___ (i.U t!~. u'""' bulk of the malformation has been I'x,"cl1<.:n" In IJul,1I10n 138 NorthernOhioLive : September 1999
  6. 6. Come see what's brewin' bomb has been defused. For now. One a( our house! tiny irregular spot remains deep inside Hunter's head, which will have to be monitored regularly. Another day, another brain saved. It's after 8:00 pm and time for Big Al to treat his two senior residents to a cele- bratory drink. Then back to the office first thing Saturday for a meeting. When told both the Severns and the Robinsons expressed amazement at the obliterated. By 6:10, Hunter's skull has long hours kept by the King, who's been reattached with delicate, titanium been known to return calls or e-mails at burr covers and screws, and doctors all hours, he replies: "I always remind Taylor and Kurpad are closing to the myself of what those people are going strains of "Wipeout" by The Safaris. through on the other side of the desk, That is until Big Al dedicates a song to and it makes it easier to do whatever is them, slipping in a tape of "Stand By necessary." Your Man" as sung by ... Big Al. When pressed as to whether he University Circle Arabica An hour later, the team awakes a toils 24 hours a day, though, Big Al groggy Hunter to make sure he can merely allows, "Only 23 and a half I'm Monday/Tuesday 7ani to llpm move all of his limbs. Wednesday 7am to Midnight not crazy." "Hi, Hunter. The operation's over. ThursdaylFriday 7am to lam Long live the king. Would you like to see your mommy?' Saturday 7:30 to lam Sunday 7:30 to 11pm Dr. Cohen says, before trekking off to After hanging in the operating room all day with Rainbow's waiting room to inform the the King, Christopher Johnston wants to release 11300 Juniper Rd. / Cleveland OH frazzled parents their son is okay. The a Big Al compilation CD. (216) 791-0300 first Impressions Last A Lifetime • WOOD TRADER Porcelain Veneers In two weeks or less: • Close Spaces • Whiten Teeth • Straighten Without Braces Teeth Whitening • Latest Technology Free Consultation for Immediate Results Scott N. Shapiro, D.D.S offers the fine art of ...for those with discerning tastes. reconstructive and cosmetic dentistry We are your complete design resource for premium quality custom framing. Our courteous and trained specialists will assist you in making the right choice to fit your needs BEACHCLIFF from our large selection of framing materials. FAMILY DENTISTRY Wood Trader Monday - Friday 13429 Cedar Road 9am - 6pm 440-333-6lS3 Cleveland OH 44118 Saturday 216'397'7671 9am -5pm 139