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Pediatric NeuroNews - Inside the Brainstem

Pediatric NeuroNews Winter 2013

Inside the Brainstem

Date: March 31, 2013

After 13-year-old Dillon Simmons hit the ice at the final buzzer of his last hockey game of the season, he couldn’t get up. His parents suspected a concussion and drove Dillon to an emergency department near their home in Ft. Myers, Fla. Dillon passed the concussion screen, but his mom, Denise Simmons, asked if he could undergo imaging, noting that Dillon had lately been leaning to one side.

“Something felt just not right,” she says. Indeed, an hour later the family was looking at an image of a golf-ball-size tumor. “It was quite apparent, right in the middle of his brainstem,” says Simmons.

Dillon was immediately air-lifted to All Children’s Hospital in St. Petersburg, Fla., for an evaluation, where neurosurgeons detected a low-grade pilocytic astrocytoma and recommended surgery with Johns Hopkins pediatric neurosurgeon George Jallo. Simmons recalls, “The neurosurgeon said, ‘I don’t want you to worry about this but it’s out of my league. If anyone can get this tumor out, it’s Dr. Jallo.’”

After the images were sent to Jallo, Simmons called him: “He said, ‘I’m absolutely confident I can do this.’” Simmons adds, “Then I could breathe a little bit.”

Dillon had only one question—would he be able to play hockey again. Jallo said “yes.”

But getting Dillon back on the ice would be no easy task, as operating on the brainstem has a slim margin for error. Jallo gains access to the brainstem through the back of the head and— after gently lifting the cerebellum—the floor of the fourth ventricle of the brain, a compact cavity rich with cranial nerves responsible for multiple functions. Nick a nerve and the patient may lose the function to hear, smile or swallow. But by using intraoperative neurophysiological monitoring of these nerves, Jallo finds a safe corridor to the tumor. Once there, he begins his innovative approach—tediously resecting the tumor from the inside out.

“By working within the tumor, and avoiding the area between the tumor and the brainstem where people have problems, we’re able to safely remove a large portion of it,” says Jallo. “If monitoring shows any activity or firing of the nerves, you know you’re getting close, so you have to limit your resection.”

In Dillon’s case, Jallo was able to remove 65 percent of the tumor; the residual tumor will be reduced in size by follow-up chemotherapy and radiation therapy. To what does Jallo attribute Hopkins’ success in such cases?

“The experience of seeing so many of these tumors and our multidisciplinary approach,” says Jallo. “Before we delve into surgery, we discuss every case at neuro-oncology conferences and come up with a consensus opinion.”

For more information: 410-955-7337

For information: 410-955-7337

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