Neurosurgeon shares inside view on pediatric spinal surgery
Dr. Jallo meets with Logan and his parents, Matt and Beth, to go over Logan's brain scans. (Photo by Robert Mang.)
My pager goes off. It’s time. Minutes later, I’m in neurosurgery pre-op, vigorously scrubbing my forearms, while running a mental checklist for my first case of the day: A 17-year-old with an “inoperable” spinal cord tumor that will require spinal surgery.
My patient, Logan McLean of Germantown, Md., was undergoing a routine evaluation for scoliosis surgery at another hospital, when an MRI revealed a 10-inch mass on his spinal cord, lodged between two vertebrae. Neurosurgeon after neurosurgeon said trying to remove the tumor would be dangerous and should be avoided. They recommended heavy doses of radiation instead. Then Logan came to me. I sensed he was a tough young man, and I gave it to him straight. The stakes were desperately high, the margin of error razor thin.
The spinal cord is our nerve-signaling highway, conducting messages from the brain to the rest of the body. One slight veer of the scalpel by less than half a millimeter can render the patient permanently paralyzed, incontinent or unable to breathe on his own. These were unlikely, but not impossible, scenarios that I told Logan about during our first meeting. Yet, leaving the tumor inside him virtually guaranteed a compromised motor function for the rest of his life. Logan contemplated the odds, and then turned to his parents: “Let’s do it.”
On the day of the procedure, I walk into the operating room and Logan is deeply sedated. My crew, a stellar cast of surgeons, nurses, anesthesiologists and surgical technicians, is ready to begin. I make the first cut, then another, peeling away muscle to reach Logan’s spine.
During the surgery, we monitor Logan’s nerve function to eliminate the chance for fatal error. We send electrical signals to his brain via electrodes then watch as the brain dispatches these signals down his spine. This is our way of making sure the spinal nerves are intact, our way of mapping the safe zones where I can cut and the danger zones I should avoid. I cut. We stimulate again. I cut deeper. We repeat: three, four, 12 times.
Five hours later, we’ve managed to remove all the rogue cells. We close Logan up. We nod at each other, knowing Logan will be fine. But he’s better than fine. At the one-month follow-up, he’s stronger. Not only did we preserve his neurological function, but we also gave Logan back some of the strength the tumor had zapped.
As a pediatric neurosurgeon at Johns Hopkins Hospital in Baltimore, I see my share of complex cases. I remove brain tumors, fix congenital brain malformations and take out inflamed, seizure-triggering brain tissue. Yet, spinal cord tumors remain uniquely challenging. Only a handful of neurosurgeons in the world take on such cases, but I don’t take reckless risks.
However, I know that sometimes one can do more harm by not taking a risk, and it’s the reason why I’ve been studying spinal cord tumors for 21 years. My goal is to find a way to make spinal cord operations routine enough that any surgeon in the world can perform them safely and effectively so children everywhere can have the same level of care.
Dr. George Jallo is clinical director of pediatric neurosurgery at Johns Hopkins Children’s Center. His first-grade report card stated: “Lack of aptitude. Hold back.” Today, he’s a world renowned A-rated neurosurgeon. Not bad for a Jordanian-Lebanese boy who came to America without a word of English.