The Pioneer: Child Becomes First Patient in Trailblazing Endoscopic Surgery that Disconnects Part of His Brain to Stop Daily Seizures
Less invasive procedure avoids large incision of previous surgery
In hindsight, as they watch their little 5-year-old boy playing with his beloved toy trucks and all things wheels, the parents of Owen Turner rest easy they made the right decision.
But nine months ago, that choice was anything but simple.
Despite trials of at least six different medications – nothing stopped Owen’s daily seizures. The Neurosciences team at Cook Children’s decided to make a pitch that’s almost too much for any parent to comprehend.
Owen’s seizures are unique in that they arise from a large area of his brain. The epilepsy team believed his best chance of becoming seizure-free was to disconnect the left side of his brain from the right. They wanted to sever the fibers (corpus callosum) that connect the two sides of Owen’s brain.
One traditional approach to this type of surgery is called corpus callosotomy, which often involves a large incision on the patient’s skin, opening a large hole in the skull, and then cutting the corpus callosum in half. While previously considered by many to be the “gold standard,” with good seizure control rates after surgery, it involves a lengthy recovery in the hospital and then at home.
While Owen’s family wanted better seizure control, they were reasonably hesitant to undertake such an invasive surgery.
Fortunately, Cook Children’s neurosurgeon, Daniel Hansen, M.D., was one of only a few pediatric neurosurgeons in the United States, who has experience doing similar procedures using less invasive endoscopic techniques.
Endoscopes (small video cameras with channels for operating tools) allow the surgeon to perform surgery through much smaller openings in the skull. When successful, this means a smaller incision, less surgical blood loss, quicker operating time, shorter hospital recovery, and the same chance of seizure freedom post-operatively as if undergoing a more traditional open surgery.
Owen’s family understood that endoscopic epilepsy surgery is the leading edge of advancement and their child would be the first such surgery at Cook Children’s, and one of only a few in the country that have been reported.
“Giving their consent and placing trust in our team, we went forward with surgery,” Dr. Hansen said. “The operation itself went well, we were able to completely disconnect the two hemispheres of the child’s brain using a bony opening not much larger than an inch square, and his recovery in the hospital was quick.”
A quick hospital stay was welcome news to Owen’s family. He’d already spent too much time at Cook Children’s fighting for his young life.
Owen’s story really begins at 8 months of age when his parents noticed weakness on his right side. His parents knew something wasn’t right with their son and they made an appointment for Monday with their pediatrician. But over the weekend they became afraid when Owen stopped using the right side of his body.
His parents rushed Owen to the nearest emergency room in Cleburne, Texas. From there, he was airlifted to Cook Children’s by CareFlight.
“We were so fortunate,” Allison Turner, Owen’s mom, said. “That's the day we met (Kenneth Heym, M.D.), who would become Owen’s oncologist. He happened to be on call that weekend. He met us there. He told us at that point, our kid was one of the sickest in the hospital. If we had waited to bring him in until the next day, Owen may not have made it.”
His initial scans showed a large stroke in the left side of his brain which soon was discovered to be related to a new diagnosis of acute myeloid leukemia. Owen endured four phases of chemotherapy and fortunately entered remission where he remains today.
While his stroke left him with right-sided weakness requiring ongoing aggressive therapy, it was his seizures that proved to be the most debilitating obstacle to overcome.
Owen’s first seizures occurred in the days following the stroke, but they were initially controlled with medication. He was able to stop taking medication shortly after his initial diagnosis, but the seizures returned around age 3.
His parents say Owen’s seizures involved periods of suddenly pausing in activity with a decreased response to them and sometimes unprovoked laughter. Other events were described as a sudden fall to the ground or stiffening and shaking of his arms and legs posing a significant risk of injury. Despite the trials of at least six different medications – nothing helped his daily seizures.
Once Cynthia Keator, M.D., took over his case, she began a workup to determine where in the brain his seizures were arising, knowing the likelihood of seizure control with medications was minimal. Owen’s evaluation in the EMU (epilepsy monitoring unit) captured many seizures starting from the left hemisphere. Additional evaluation with a MEG (magnetoencephalogram) scan showed multiple areas of abnormal electrical activity throughout the left hemisphere both in front and behind the region of his prior stroke.
With options running out, the Neurosciences team suggested the trailblazing endoscopic surgery and introduced the family to Dr. Hansen.
Owen is now 9 months out of surgery and the family has noticed no seizures since. He’s an active young boy, playing with his monster trucks, who is making steady strides in kindergarten now that his uncontrolled seizures have stopped. While it remains too early to speak to years of seizure control, doctors say this is an encouraging start.
“After everything we’ve been through, I don’t know if you ever say you are comfortable. I guess we’ll always be on guard,” Allison said. “But we’re a little more relaxed now. Before the surgery, we never knew when a seizure would come on. Owen couldn’t go outside and play without one of us with him.”
Given the successful outcome with Owen, Cook Children’s has since performed two additional endoscopic procedures with similar favorable results. The Epilepsy team hopes to expand the number of children who are candidates for this type of surgery in the future. Such children will have medically refractory epilepsy and will have undergone a thorough evaluation by the team at Cook Children’s. Potential surgeries that can be performed endoscopically include complex surgeries including corpus callosotomy, single lobe disconnections, focal lesion resection, and functional hemispherectomy. As the team’s experience grows with this technology and technique, its use may expand beyond this short list.
And in the process changing more lives for the better.
“It has been such a relief for us. It was a huge decision to disconnect his brain. Just saying those words … But this was the best thing for him,” Allison said. “He has flourished. He’s made improvements by leaps and bounds. He has progressed in everything. His speech, school work, everything. His whole body is functioning with just the use of one side of his brain. He can’t throw a football with his right hand and he has problems with his fingers on his right hand. He can’t pick up a Cheerio with his right hand. But other than that, I don’t know if anyone would notice a difference in him and any other child.”
Get to know Daniel Hansen, M.D.
Dr. Hansen is a neurosurgeon at Cook Children's. Brain surgeries are often microscopic, such as revascularization, where doctors take vessels from the external circulatory system of the head and internalize them to make new pathways for blood to flow. Our state-of-the-art surgical facilities, extremely skilled neurosurgeons, and highly advanced diagnostics all come together to provide your child with world-class care during even the most intricate and delicate surgeries.
The neurosurgeons at Cook Children's are extraordinary, both for their amazingly skilled hands and for their immense commitment to each and every patient that they treat.
When a child with a neurological disorder requires surgery, the experts at Cook Children's Medical Center offer comprehensive care and state-of-the-art technology.
With the help of such state-of-the-art equipment as the revolutionary intraoperative MRI (iMRI), our neurosurgeons are able to determine the effectiveness of surgical procedures for cranial and spinal nerve disorders and tailor the treatment to each child's unique needs. Find out more about the conditions treated and how this team is leading the way in advanced treatment by clicking here.
The Arcuate, from the Jane and John Justin Neurosciences Center, provides information on new programs, innovations and our continued efforts to bring the best neurosciences care to the patients of Cook Children's, the state of Texas, and beyond. Click to read more.
Latin for "curved bundle," the arcuate fasciculus is essential to communication, as it connects Wernicke's area (receptive speech) to Broca's area (expressive speech) in the brain. Without it, we could never effectively convey our ideas, accomplishments and plans for the future.