Focusing On Patients

Beating a brain tumor
(continued)

"Franklyn was very nervous and frightened about the fact that he had something growing in his head," said Mandy. "We had surgery scheduled for November of 1999, but I asked them to move it up a month because he was starting to act out at school."

Surgery, a mainstay of brain tumor treatment, has improved in the last 10 years because of the ability to do intra-operative mapping of the brain, said Boggan. "We're better able to define the sensitive areas of the brain."

Another improvement lies in the area of neuronavigational surgery, also known as image-guided surgery. Surgeons use special probes equipped with infrared light-emitting diodes and optical scanners. These probes detect the infrared light and transmit it back into a powerful workstation computer and a video monitor, giving surgeons a three-dimensional map of the patient's brain. The computer-generated map is derived from preoperative MRI scans.

In this way, neurosurgeons can see where their instruments are in the patient's brain, skull or spinal column, in real time. The technology lets surgeons see how much of a tumor they have removed, allowing them to make smaller, more discrete cuts.

But removing the tumor would not necessarily cure Franklyn's seizures. To pinpoint the epicenter of seizure activity, doctors performed intracranial electroencephalography (EEG) to measure electrical impulses in his brain. It's just like the common test given to people with epilepsy, but in this case, the thin strip electrodes that measure activity were placed directly on the surface of the brain.

The effort paid off. "We knew where the tumor was, but we determined the seizures were coming from a different area, the inferior temporal mesial hippocampus," said Zusman. "The tumor was located in a pathway to a very sensitive area of the brain, and it had disrupted normal fibers."

The surgery to remove the damaged neural tissue is very similar to a surgery performed to cure people with chronic epilepsy.

That's when baseball, Cadillac and hamburger became important.

The night before his surgery, doctors asked Franklyn Barber to remember those words, chosen for their randomness. Even with precision surgery, physicians couldn't be sure how his memory would be affected until afterward.

The next morning, Franklyn repeated his neurosurgical mantra: Baseball. Cadillac. Hamburger.

"When Dr. Zusman came out of his room after surgery, she was so happy," recalled Mandy. "That's when I knew I could be happy, too."

No problem.