Week 2

This last week I witnessed one particularly interesting cases. This is a 14 year old boy, who had to undergo his first crainotomy as young as age two. The main complaint he came to see Dr. Schwartz about was severe recurring seizures. Dr. Schwartz sees a lot of patients (generally adults though) with these symptoms and often this is a two step procedure where in one surgery, several electrodes are planted near the suspected site of seizure and are used over the next week to identify both the origin of the seizure and to map out where certain functional areas are exactly (such as those responsible for motor movement or language). If the seizure locus is distinct enough from these functional areas, it can be removed in a second surgery. This boy, however, also had a significant AVM in his right lobe. This is an Arterio-Venous Malformation, which is an abnormal collection of blood vessels. As Dr. Schwartz is not an expert with this and there is a significant risk involved if this AVM is ruptured, he decided that he first needed an okay from another physician to proceed with a surgical option here. He also suspected that due to this AVM from such a young age, the right lobe may not have any significant functioning and could be removed altogether, eliminating both the seizures and the risk of sudden rupture of the AVM in one big surgery. The boys movement on the left side is significantly limited as well as his visual field, and Dr. Schwartz suspects that this limited ability may be from the left lobe taking over certain functions in early development. If this were the case, the boys right lobe would be removed altogether and both his quality of life and life expectancy could be improved drastically. In order to check this, Dr. Schwartz first needs an okay to go ahead with surgery and then can check during surgery where the functional areas are exactly. I am not yet sure what this surgical procedure would be like exactly, but I believe the patient actually has to be awake and conscious during this to test whether certain areas have certain functions. This is obviously another consideration, especially in a 14 year old boy, but the potential benefits could greatly outweigh the discomfort of such a surgery.