Friday, July 31, 2009

Ancient brain surgery technique saved the life of an elderly woman

Using a technique that dates back to the Stone Age, one of New Bedford's premier neurosurgeons recently saved the life of an elderly but feisty Acushnet woman who suddenly started bleeding deep in the back of her brain.

There is evidence that, 7,000 years ago or more, Neolithic medical practitioners — such as they were — performed the technique, perhaps to release evil spirits from the afflicted. During medieval times, physicians did the job to restore the balance of the body's four humors.

Trepanation, in which a hole is drilled through the skull to expose the brain, was a widespread practice in the ancient world. It has been performed, since prehistoric times, to treat such conditions as mental illness, seizures, migraines and head wounds.

Had trepanation been performed on a patient such as 90-year-old Irene Andre, the ancient medical practitioner would have actually been on the right track, according to Dr. Aubrey Okpaku of SouthCoast Neurosurgery, part of the Southcoast Health System.

Okpaku says he used essentially the same ancient cure (now called a craniotomy), but with the advantage of modern imaging techniques to tell him exactly where the blood on Irene's brain needed to be drained.

Unlike the practice of ancient trepanation, however, Okpaku did not leave behind a large open hole in his patient's skull or keep the removed piece of bone as a charm against evil spirits.

Though nobody would ordinarily think to compare the highly developed 21st-century skills of Okpaku to his ancient predecessors, he himself did in Irene Andre's case.

Okpaku has a distinguished history of high-tech surgeries to his credit. Before coming to the Southcoast , he was part of the surgical team at Montefiore Medical Center in the Bronx, N.Y., which five years ago separated twin boys born joined at the head.

"That was ground-breaking," the neurosurgeon says. "That was extraordinary."

For Irene Andre's family, her treatment was just as extraordinary, but Okpaku refuses to take credit for her recovery, despite the fact that, without his intervention and expertise, she would certainly have died within 48 hours.

"I don't mean to be glib, but someone was looking out for her other than the hospital staff," insists Okpaku. "The factors that led to a good outcome for her were not in the hands of the medical community that took care of her."

The "point of irony" in his intervention with Irene, Okpaku says, is that it entailed "the oldest surgery in the history of mankind. Three thousand years ago they were drilling into the skull to reduce the pressure on the brain. That's basically what I did."

Nevertheless, Irene's family is grateful to him and the entire St. Luke's Hospital team that saved the Acushnet great-grandmother's life while also preserving all of her mental and physical faculties.

Though she remembers nothing of the surgery, Irene clearly recalls the day her brain started to bleed.

On a Tuesday morning last February, Irene was going about her regular household tasks.

"I putter around," she says. "I'm a putterer."

However, as the morning progressed, she became increasingly unable to coordinate her movements or hold up her head. She remembers curling herself onto the closest chair and calling out to house guest Peter Soucy Jr. for help.

Irene knew something was very wrong, but she wasn't in pain.

She recalls, "I wasn't feeling good. I sat sideways and made like a bridge out of my hands to hold my head."

Even while in the ambulance on her way to St. Luke's and during triage in the emergency room, she was able to fight through the disorientation caused by the bleeding, says son Jim Andre. His mother was able to answer correctly when the medical staff asked her standard assessment questions — who is the president, what year is it — despite the increasing pressure of blood pooling in the back of her skull and pressing on her brain stem.

"When I was called in," Okpaku comments, "I thought I was going to find my patient comatose and on her way to a better place. Most people her age would have died before I ever saw them."

Okpaku says that Irene Andre's cerebral hemorrhage was likely due to a simple weakening of a small blood vessel inside her brain that eventually started to leak. Unlike an aneurism, which forms in large vessels on the surface of the brain and, when it bursts, causes blood to pour out quickly, Irene's smaller bleed may have been seeping into her skull for up to two hours before she noticed symptoms.

Her bleeding was in the posterior fossa, which contains two vital structures: the brain stem and the cerebellum.

Okpaku explains that injury to the brain stem affects respiration, wakefulness and nerves to the face that control functions such as eye movement, tongue movement and chewing. The cerebellum controls movement of the arms and legs.

Ironically, the fact that aging brains tend to shrink up to 25 percent may have provided Irene the extra space she needed during the emergency to withstand pressure inside her skull without damage to her brain.

The most common reasons for the brain's vessels to weaken and bleed, Okpaku says, are long-standing hypertension, diabetes or amyloidosis (protein deposits inside vessel walls). Irene had none of these conditions.

Faced with the tremendous responsibility to choose between life and death for his mother, Jim Andre says he didn't hesitate to approve Okpaku's suggestion that a craniotomy could save her life.

"We were told that if we did nothing, she'd die peacefully within 48 hours. They said the surgery was risky, and that there was no way to tell what shape she'd be in if she survived it. But, we figured a small chance was better than none at all," Andre recalls.

Four hours later, Irene came through her surgery with a small hole drilled into the base of her skull where Okpaku found the troubled blood vessel and stopped it from leaking.

He drained off the pooled blood and made another small hole in the top of her head to insert a drain that kept her cranial pressure under control for several days while the nonagenarian healed.

After a week at St. Luke's, Irene went to a nursing home for several weeks of recovery and physical therapy.

Now, she's back home singing, dancing and watching her favorite horror movies once again with her husband, James, to whom she's been married 58 years.

"I feel good. They saved my life," Irene says with a grin.

As for Dr. Aubrey Okpaku, he's still not taking the credit, even though he moved to the SouthCoast precisely because he was looking for a home where he could make a difference in the community.

"Speaking as a neurosurgeon," Okpaku says, "I'm constantly working to understand and heal the most complex structure known to man (the human brain). We don't know what we're dealing with most of the time.

"Most neurosurgeons have a great deal of humility."

Contact Pamela Marean at pamelamarean@pamela


Post a Comment

<< Home