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    Sutter Children's Center, Sacramento

    Anthony - Brave 5-Year-Old & Gamma Knife

    Anthony -
    Anthony - Brave 5-Year-Old & Gamma Knife

    Tammy finished her shift as a cashier at the Goodwill store on Arden Way, returned to her apartment and found her son Anthony complaining. "Ahh, my head hurts," he whined. A warm shower and a snack, she thought, would help her 5-year-old feel better. But the freckly faced redhead got worse. He lay on the loveseat screaming, his mouth twisted to one side, his little limbs shaking, his eyes rolling up and back. After a frantic ambulance ride to Sutter Memorial Hospital, Anthony was admitted to the intensive care unit with a rare congenital abnormality, a tangle of vessels that had ruptured and were now spilling blood into his brain.

    The diagnosis -- a bleeding arterio-venous malformation -- not only put Anthony in grave danger, but left his mother and the doctors overseeing his care facing a dilemma. Brain surgery to remove the malformation and stop the bleeding could kill Anthony or, at best, leave him paralyzed, blind or with severe language and mental disabilities.

    Waiting out the hemorrhage could be deadly, too. But if he survived this, neurosurgeon and medical director of Sutter Neuroscience Institute Pediatric Neurology Sam Ciricillo, M.D., FACS, told Tammy, her son would likely be an excellent candidate for gamma knife treatment. A precision dose of radiation through the gamma knife could destroy the abnormality, eliminate the risk of additional bleeding and give him a shot at a normal life.

    Two and a half months after that trip to the emergency room, Anthony was back home, raising havoc with his little half-sister Jada, ready to return to his kindergarten class at Greer Elementary School and jumping up and down on his mother's loveseat.

    This day almost never came. Shortly after his hospital admission, a special X-ray of the vessels surrounding the malformation convinced Ciricillo and fellow neurosurgeon Edie Zusman that the safest approach was to let Anthony wait out and recuperate from the hemorrhage.

    It was a calculated risk. "It's never easy to sit and watch a child get sicker," Ciricillo said. "But sometimes you have to take a chance that the child is going to get sicker to get a better outcome in the long run."

    Tammy put her trust in the surgeons. "I am not a doctor, so I don't know," she said. "What else am I going to do? I was just really wanting my baby to be alive." Relying on her boyfriend and others for help with her other child at home, Tammy spent day and night at the hospital, eventually abandoning her job and taking on debt to stay by his side.

    At first, Anthony just got sicker. The bleeding on his brain caused swelling and dangerous pressure inside his skull. He was lapsing into a coma. To increase his odds of surviving, doctors used strong sedatives to keep him comatose and immobile. They hooked him up to a ventilator to help him breathe and covered him with a cool blanket to quiet his restless body and mind so he could begin to heal.

    But Anthony continued to deteriorate as the brain pressures kept rising. After three days in the coma, Zusman opted to perform a risky procedure to relieve the pressure. She drilled a tiny hole into Anthony's skull and inserted a drain to remove a small amount of cerebral spinal fluid. "It was clearly a life-and-death situation," said Zusman. "The goal was to get the best long-term outcome, for him to be able to move his arms and legs and have a joyful life."

    The risk paid off. Anthony's condition steadily improved, the pressure gradually dropping to normal levels as excess fluid dried up. "When the brain swelling is that severe, a tiny volume difference makes a huge difference in pressure," explained Ciricillo. After 11 days, Anthony was eased out of the coma. When he awoke, he was alert but the hemorrhage had left him weak on his left side and temporarily unable to walk.

    By the end of April, Anthony had regained most of his physical strength and coordination. He was ready to undergo the gamma knife treatment. Anthony seemed almost eager on Thursday to get the job done, helping the gamma-knife nurse push a cart full of equipment through the hospital corridors and hardly wincing when the anesthesiologist inserted a needle into his tiny hand to start the medicine that would sedate him for the next several hours.

    A frame was secured onto Anthony's head, and the medical team -- a radiation oncologist, radiation physicist and Ciricillo - used measurement tools and magnetic resonance images of his brain to pinpoint the location and geometry of the malformation and to develop a computerized treatment plan.

    Anthony was then placed on the gamma knife table, his head inside a 350-pound titanium helmet dotted with 201 14-millimeter holes through which the tiny radioactive beams -- or gamma knives -- would seep.

    Doctors would not know for several weeks or even months how well the radiation worked to destroy the malformed vessels and shut down their blood flow. But a few days after surgery, Anthony was back playing video games and gleefully tormenting his little sister. And nearly a year after, Anthony was back to his normal childhood activities of running and playing with his friends. He no longer has seizures or headaches and all his scans show that the arterio-venous malformation is considerably smaller and may even be obliterated already.

    Learn more about Sutter Neuroscience Institute’s Gamma Knife Radiosurgery Center.


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