Dr. Mark Lee's neurosurgical team huddles around Greg as they prepare to remove the part of the brain believed to be causing his seizures. JEFF JANOWSKI/STAFF

Saving Greg: Additional surgery needed

Web posted November 14, 1999

 The surgery
 Additional surgery needed
 Recovery
 Progress fades
 After the surgery
 View the picture story

Story by Tom Corwin
Photographs by Jeff Janowski

Aug. 18, 9 a.m.

Delving into Greg's brain last time was a laborious process. Now it takes just minutes for Dr. Lee and Dr. Brown to cut through sutures holding the skull cap and peel back the layers underneath. The exposed brain is covered by small, dark blood clots.

Today the surgeons will cut out the part of Greg's brain where his seizures appear to start.

``The issue is, do you remove what's right there, or do you remove more than that,'' Dr. Lee says from under his green surgical mask. The seizures have proven to come from a broad area just ahead of the motor areas that control movement. Taking out just the areas that showed up during the monitoring process could leave behind pieces that could trigger further attacks, Dr. Lee says. He decides on a prefontal lobectomy, taking a fist-size wedge of the seizure area but leaving a small piece at the front of the lobe.

Though the mask covers most of his face, Dr. Lee looks and talks younger than his 40 years. After spending some time as a ``ski bum'' after college, he joined the military to help pay for medical school. He jokes easily with the staff around the table and seems to move effortlessly when the scalpel is in his hand. He was named head of pediatric neurosurgery the month before Greg's surgery.

Click on graphic to view a larger version. JOHN W. FLEMING/STAFF

Dr. Park walks into the operating room, preoccupied with a sheet of paper. Dr. Park, 48, has been with MCG since 1991, long enough for some of his pediatric patients to grow taller than he is, he jokes. He is quiet and studious, and he will work with the family the longest, patiently explaining things and scheduling follow-up visits.

Dr. Park stares down at a small map showing the targeted section of brain tissue. The numbers of the electrodes that detected seizure activity are plotted out in a grid that stretches across the middle of Greg's brain. Dr. Park and Dr. Lee huddle over the map, looking back and forth from the map to the brain, sizing up the cut.

``Forty-six is border, I don't want to touch that,'' Dr. Lee says, looking at the numbers drawn on the map. ``Twenty-nine, if I don't have to touch it, I don't want to.''

Carefully picking up lettered squares of paper, he begins to stagger them in a line down the center of the brain, looking at the map to judge his placement, then reappraising the line.

``B, I don't like B. I'm going to move B,'' Dr. Lee says, picking up the tiny letter and moving it closer to the front.

After less than a half-hour of cutting, Dr. Lee places a fist-size piece of Greg's brain in a dish. JEFF JANOWSKI/STAFF

Carefully, Dr. Lee aligns a white gummy strip down the line of letters, gauges it, then carefully picks up the letters. He eyes the line, his head cocked slightly, then gently tugs a section this way, gently pushes another that way, lining it up.

``OK,'' he says finally, ``let's do it.''

Centimeter by centimeter, he begins edging down the line with a cauterizing probe. A dark line of incision forms behind his fingers. Being able to find a single lesion where the tremors originate usually results in about a 90 percent success rate, Dr. Park says. In a broad area like Greg's, it is much more difficult to spot because once one portion fires off ``within milliseconds the whole area is involved,'' Dr. Park says. Surgery in this case has about a 60 percent cure rate, Dr. Park says.

The Wests' pastor, the Rev. Terry Greene of North Gate Colonial Baptist Church in Camden, prays with Lynne and her mother, Evora Price, during one of the surgeries. JEFF JANOWSKI/STAFF

Whatever functions that area of the brain performed have long since been eclipsed by the constant seizures, and other parts of the brain have compensated, Dr. Lee says. The piece they plan to take, however, will result in some temporary paralysis on the left side of the body, which the right brain controls, Dr. Lee says. Nearly all of the children recover the function, however.

``Your brain has to get used to not having (the piece),'' he says.

With what looks like tiny scissor blades, Dr. Lee carefully begins cutting down the line he etched toward the top of the skull, then goes back through, deepening the slit.

The cuts are deepened, and then carefully with forceps, he lifts the edge at the bottom of the moon shape and begins cutting underneath, snipping white fibers, slowly peeling it back, until it comes free.

``There goes most of the epilepsy right there,'' Dr. Lee says. It took less than half an hour of cutting.

He gently places the brain tissue into a specimen jar, and it seems to shrink. Later, it will be studied under a microscope to see if there were abnormal cells that could give doctors a clue as to what was causing the seizures. They will find none.

After carefully washing out the crater left behind, Dr. Lee begins cutting again, deepening the wedge, then cutting underneath the piece of the lobe left at the front, disconnecting it from the rest of the brain.

Kneeling at the bedside of his unconscious 10-year-old son after the second surgery, Dennis, overcome by emotion, begins crying quietly. JEFF JANOWSKI/STAFF

``It's just going to be sitting in there, disconnected, having all the seizures it wants. It's not going to be communicating with his normal brain,'' Dr. Lee says.

He ends with a wedge 2 inches wide at the bottom, tapering to less than an inch at the top and about 2 inches deep. The space will eventually fill with cerebrospinal fluid, Dr. Lee says.

Less than three hours after he cut the sutures to go back in, he begins sewing up again, eventually attaching small, square metal plates around the edges of the skull to hold it together.

Four floors above the operating room, the Wests are gathered in a circle holding hands with their minister and praying. The strain shows on their faces before Greg is wheeled in.

Kneeling next to his bed, alone for a moment, Dennis bows his head and finally breaks down, crying quietly next to his unconscious child.