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Lifesaving Brain Work

For These Three Children, Prompt Care From Skilled Pediatric Neurosurgeons Made A Crucial Difference

Pediatric neurosurgeons operate on the body’s most complicated structure: the brain. At Maria Fareri Children’s Hospital at Westchester Medical Center, they treat children with a variety of problems, including brain tumors, epilepsy, congenital malformations, trauma from an accident—even stroke. (Read about a young stroke victim on page 18 of the April–May Health & Life.) The families of three children are especially grateful for the skill, dedication and teamwork of the hospital’s two pediatric neurosurgeons and co-division chiefs—Avinash Mohan, M.D., and Michael Tobias, M.D.—and their team of pediatric nurses, nurse practitioners, anesthesiologists and other professionals. Here are their stories:
Solving a Double-Vision Mystery
In September 2011, then 13-year-old Laura Chapman had double vision during a soccer game. In the next two months it became frequent, and fatigue began to overtake the usually energetic Pleasantville teen. Her parents—Jeff, an advertising executive, and Ruth, a stay-at-home mom to Laura and her 17-year-old sister, Cary—took Laura to several doctors, but tests were inconclusive until an MRI (magnetic resonance imaging) scan found a skull-size abnormality called an Arnold-Chiari malformation. She was referred to Ronald Jacobson, M.D., Maria Fareri Children’s Hospital’s Chief of Pediatric Neurology. He called in Drs. Mohan and Tobias, who performed surgery right away.  
The malformation is an unusual constriction of brain tissue that controls balance, which is why it was hard to diagnose at first. “Dr. Mohan told us her case was unusual because double vision is not a common symptom,” Ruth Chapman says. “It’s usually balance problems and headaches, which she didn’t have.” 
The treatment is not to remove the extra tissue, but to remove portions of the skull bone that this tissue presses against, thus relieving pressure on the brain. It took two months for Laura’s vision to return to normal—a typical recovery period—and since then she has been symptom-free. She did have to give up contact sports, such as soccer, to avoid head trauma. So she has taken up tennis, her mom says. 
She also has continued her work as an artist. She paints scenes of nature, many of them from her family’s vacations in Nantucket, and even presented a calendar of her paintings to Dr. Mohan and the pediatric neurosurgery team. “Through the whole process, the doctors were totally approachable and dedicated to making me better,” says Laura. “I was impressed with how they worked as a team.”  
Saving an Injured Teen 
Last July 4, after a family barbecue in his Clinton backyard, 16-year-old Ryan Mackin rode his bike to a friend’s house just a mile down the road. “Ten minutes later the phone rang,” says his mother, Carol. “It was his friend, screaming, ‘Ryan got hit by a car!’” 
Carol, her husband, Tom, and their 12-year-old son, Kyle, raced to Ryan’s side. By the time they got there an ambulance had arrived and was readying him for a trip to the nearest community hospital. A CT (computed tomography) scan revealed a fractured skull and showed blood pooling in the back of his head. The chief of critical care at the hospital knew that Ryan was in grave danger and needed the care of a Level I trauma center. In the Hudson Valley, the Joel Halpern Trauma Center at Westchester Medical Center is that place. 
“Pressure against the brain stem can be dangerous—it can cause breathing to stop,” says Dr. Tobias, who met the Mackins when they arrived. He removed the back of Ryan’s skull to allow the brain to swell unimpeded, but the pressure in his brain continued to rise. So the doctors had to try a radical surgery called bilateral hemicraniectomy—they took off both sides of Ryan’s skull to relieve the pressure. It worked, and when the swelling subsided fully, several weeks later, the skull pieces were replaced. 
Ryan has no memory of the accident, but today he says he feels “like myself again—I even got my hair back.” He can’t play sports until next year, but he did go hunting last fall (his parents own and operate a hunting preserve) and bagged an 8-point deer. He’s given up bike riding for a while. “I’m getting my driver’s license soon,” he says. 
“Ryan was very sick and we were lucky to save him,” Dr. Tobias says. 
“The community hospital’s quick work to get him here, in a Level I center with a comprehensive team of professionals, was key, because time can be crucial in trauma cases.”  
Removing a Stubborn Tumor 
In Mahopac, on New Year’s Eve 2012, 8-year-old Jaimie Ferretti had headaches and vomited once, but it passed, and her parents—Dan and Debbie—thought little of it. When the headaches returned a few days later, Debbie took Jaimie to a pediatrician, who ordered a CT scan. “We got a call telling us she had a mass on her brain, and I fell to the ground,” Debbie says. Dan took the phone and learned that an ambulance was coming to take Jaimie to Maria Fareri Children’s Hospital at Westchester Medical Center.
Later that afternoon, the Ferrettis met “the amazing Dr. Tobias and Dr. Mohan,” Debbie says. “They told us it was a brain tumor, but wouldn’t know what type until it was removed.” Her operation began the next morning at 10 and lasted several hours. “Dr. Tobias came to see us at 2 a.m. the next morning and said they got the whole tumor,” Debbie says. “He said she actually got stronger during the surgery—they could tell.” 
Jaimie’s tumor was an ependymoma, Dr. Tobias says. “It’s a common pediatric brain tumor, and we don’t know the cause.” Now that Jaimie has been tumor-free for a year, her odds of a cure are very good, he says. And she was appointed Grand Marshal of the hospital’s 2013 Go the Distance Walk and Family Fun Day. 
Jaimie was in the hospital for 12 days, but has required no radiation or chemotherapy. “She needed no physical therapy, nothing,” Debbie says. “I can’t tell you how wonderful everyone there was. They saved my daughter’s life, and I want to hug them every time I see them.”

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