'HE IS THE ONLY PATIENT WITH THIS KIND OF A BRAIN TUMOUR ... TO BE CURED FOR OVER 50 YEARS'
The patient In November, 1953, 24-year-old Murray Graham of Kemptville, Ont., was suffering from seizures that began in his right foot and moved up his body.
The doctor Neurosurgeon William Feindel suspected a tumour near the motor cortex, the part of the brain that controls movement.
The operation An exploratory craniotomy. Dr. Feindel would open Mr. Graham's skull while his patient was awake and look for a cancerous growth. He found one, but he had to carefully map the motor cortex so that he would know how much growth he could safely remove without leaving Mr. Graham paralyzed.
Mr. Graham
I used to go to bed with National Geographic to grab and put between my teeth. The seizures were very severe. They started in my foot - it would shake and tremble - and came up to my waist. I scared everybody in my family.
The medication didn't hold the seizures, and made me kind of dozy.
My doctor said there was only one place for me to go: Montreal. So I came to the Neuro. At that time, when you went to Montreal, it was pretty much the end of the story.
Dr. Feindel
We explained to Mr. Graham that the seizure was due to something very local, affecting his motor and sensory cortex, the parts of the brain that affect movement and feeling.
Something was there that had to be taken out; we didn't know what it was, but we thought it best to have a look.
Mr. Graham
I remember being brought back and forth out of consciousness. I don't remember any discomfort. It was a long process.
Dr. Feindel
We made holes in the skull, and cut between the holes with a flexible saw. The bone flap was about 12 centimetres by 12 centimetres. When you remove it, you see a membrane that looks like a wet piece of shammy. It has to be opened very carefully.
The brain itself is sort of a cream colour. The tumour was slightly reddish. It was pushing the brain aside, popping up like a cork two inches wide.
We were very satisfied to see it, but we were a little dismayed it was in a very vulnerable area of the brain, in terms of giving Mr. Graham a severe neurological deficit like paralyzing his leg or his whole side.
Fortunately it wasn't invading the motor cortex, but the sensory cortex just behind it, which is responsible for feeling in the foot and the leg.
We didn't want to go in blind, and damage the motor cortex and leave him paralyzed. I had a platinum wire, three or four inches long, and the handle is made of glass. It would deliver a small electrical current.
The anesthetist would watch carefully to see a movement, or the patient would feel a movement. Point by point, we mapped the motor cortex, so we could protect it.
Mr. Graham
It was a strange new world, but the Lord was with me. I told the Lord that if he would raise me up, I would serve him.
Dr. Feindel
We did a small biopsy and sent it up to the lab, and that showed the tumour cells were there. It was important to have as complete removal as possible. I used a small needle microsuction to suck it out.
Mr. Graham
My father came to take me home. I had radiation in the Ottawa Civic Hospital, 20 treatments.
Dr. Feindel
Damage from radiation in the brain is fairly common, and may take 10 or 15 years to come on. He didn't get that. At the Ottawa Cancer Clinic, they made a special plaster and wax skull cap to radiate an area only twice the size of the tumour. That was an enormous advantage not yet widely used in the 1950s.
Mr. Graham
I went back to school afterwards. I studied theology at McGill and then went to Presbyterian college and into the ministry. I worked in New Brunswick, and retired in Moncton.
For 50 years, he was only a name, and one Sunday night about six years ago, the phone rang. He said, "I'm Bill Feindel, and I am phoning to see how your health is. Do you ever come to Montreal? I would like to see you."
I went up to the Neuro. We've been in contact a few times since then. In August, he asked if I would be interested in coming back for the 75th anniversary. How many of us get a chance to go back and thank our doctors?
The surgery was successful. I'm 80 years old now, you see.
Dr. Feindel
He is the only patient with this kind of a brain tumour reported in the medical literature to be cured for over 50 years. So the exploratory operation with the patient awake to map the brain was justified.
*****
'WHEN THEY OPENED THE AMBULANCE DOORS AT THE NEURO, MY FAMILY JUST CRIED'
The patient Montreal high-school principal Roma Medwid, 53, was having trouble sleeping in the early hours of Oct. 1, 2005, when a blood vessel burst in her brain.
The doctor Donatella Tampieri is a specialist in sealing off aneurysms from inside the blood vessel, without having to open the skull.
The operation The doctor would thread a tiny catheter into the patient's groin and up to her brain. Once she reached the aneurysm, little platinum coils would be detached to repair the tear. But there was a risk of a deadly complication.
Mrs. Medwid
I knew exactly the moment it popped. I felt this nudge, and the warmth spreading on the right side. I knew something was terribly wrong. I sat up in bed; I have a wall of windows in front of my bed and I could only see half of them. The sound was muffled on one side. Then the pain took over. I knew I was dying. The doctor at the Jewish General Hospital said, "You have a brain aneurysm. We have one chance to save you."
They packed me off in an ambulance to the Neuro. When they closed the doors, my son was told they didn't know if I would be alive at the other end. The ambulance driver tried to avoid the potholes. When they opened the ambulance doors at the Neuro, my family just cried.
Dr. Tampieri
I do 70 aneurysms a year. They are all different. One-third of patients with a leakage die; one-third come out of it with good outcome, but some neurological deficits; one-third are back to normal.
She had a relatively small leakage on the right side, at the back of the brain, but even small ones can be nasty. They can bleed and kill. In the last 15 to 20 years, instead of opening the head and putting in a clip, we go in through the blood vessel. This technique was described in the nineties and has advanced quite a bit since then with coils of different materials and softness. It allows us to navigate to the lesion without disturbing the area around it.
When we inject the dye, it gives up a road map of where we want to go. The micro-catheters are a bit thicker than a human hair. My favourite ones are purple. We went up the femoral artery. The coils are at the end of the catheter. They are super-fine, like a hair, you can barely see them. When you arrive there, we detach the coils and apply an electrical current. But you have to be in the right place.
Her aneurysm was the size of a chickpea, quite round and nicely shaped. It took six platinum coils to repair it. If you need to have an aneurysm, that is the one to have.
Mrs. Medwid
I woke up. I said a prayer of thanks. I was experiencing excruciating headaches.
They told me the blood that bled from my aneurysm could cause my brain to spasm. I had left the intensive-care unit when my blood pressure dropped and I felt immediate paralysis on my left side. They opened up a line in my jugular to get my medication in fast. They brought me back one more time.
Dr. Tampieri
Afterwards, she had what is called a vasospasm, a narrowing of the arteries of the brain where they are in contact with the blood. You can have a stroke and have a deficit, stop moving hands, stop speaking. In her case, medication increased the volume of the blood, and relaxed and dilated the arteries of the brain.
Mrs. Medwid
After 19 or 20 days, I went home. I still had headaches 20 out of 24 hours. They were 100 times worse than migraines. Gradually over time, they diminished. I went back to work in February, 2007. I have applied for two new jobs and got them.
I'd do anything for Dr. Tampieri. I owe my life to her, and the fact that I have all my cognitive abilities. I met her a year later, when I went back for a CAT scan. I had no idea she was so small. There was this four-foot-one little bombshell.
Dr. Tampieri
I never recognize my patients when I see them a long time after the surgery. They look very different when they are flat and in distress, and here is this tall blonde with lipstick.
It feels good to meet patients afterwards. It feels very, very good.
*****
'I STARTED TO HAVE A LOT OF SEIZURES, UP TO 80 OR 90 A DAY. THE PSYCHIATRISTS TOLD MY PARENTS I WAS FAKING'
The patient Seventeen-year-old Dominique Riel of Montreal was incapacitated by up to 90 severe seizures a day in the spring of 1990.
The doctor Neurosurgeon André Olivier, an expert in treating epilepsy, quickly became convinced that only radical surgery would help the teenager.
The surgery The removal of almost all of the right side of her brain, known as a modified hemispherectomy.
Ms. Riel
When I arrived at the Neuro, I was in the fetal position in a wheelchair. I weighed 82 pounds and couldn't see because my eyes were blinking all the time from the seizures. I was incontinent.
I had had about one seizure a month from the age of 5, but they were controlled with medication. When I was 12, I became aggressive and had behaviour problems. I kept trying to run away. My mother called a psychiatric hospital; they hospitalized me.
Over the years there, I started to have a lot of seizures, up to 80 or 90 a day. The psychiatrists told my parents I was faking.
I told my mother I was dying and that she had to take me to another hospital.
Dr. Olivier
She was very, very incapacitated. Essentially her quality of life was zero.
The diagnosis was Rasmussen's disease, first described by Theodore Rasmussen, a former director of the Neuro. It is a terrible disease that causes cells to die off in the brain, causing seizures that become extremely disabling. It is probably autoimmune in origin - the body's immune system attacks healthy tissue.
Almost invariably, it is one side of the body that has the seizures; in her case, it was the left side of the body and the problem was in the right side of her brain.
The X-rays and MRI were quite striking. You can see the right hemisphere that was smaller and quite damaged. You see progressive destruction, progressive atrophy of the brain.
We had done 50 cases like this at the MNI, and the conclusion was you have to remove most of one side.
Ms. Riel
Dr. Olivier said, "Don't worry, I am going to operate on you." Finally someone believed me.
I arrived the first week in May, and I had my surgery the 27th of June. It was life or death, but I wanted to have peace in my body.
Dr. Olivier
The brain tissue was rubbery, hardened. We didn't remove the entire hemisphere, but close.
It is radical surgery, but if we hadn't done it, I think she would have remained in an institution, isolated and progressively becoming demented.
Ms. Riel
They took out the right side of my brain, so I am paralyzed on the left. After the surgery, the nurse came to turn me, like a piece of bacon, every half-hour.
After my surgery, I could see for the first time in two years, although I can't see in the left field of both eyes. I really appreciated not to have any seizures. So peace was coming.
Two or three days after the surgery, I decided I wanted to walk. My mother helped me. After one week, I decided to stop my wheelchair at the end of the ward. I walked to my bed.
Everybody told me, "Don't do it, you're going to fall."
I said, "Big deal, I won't go all the way to China."
Dr. Olivier
After the surgery, she became herself. One of the things that characterizes her is she was extremely motivated. She embarked on a systematic program to get her left side of her body moving. She followed it religiously.
I think what has happened with Dominique is the phenomenon of plasticity, that the normal side, the left side, is taking over the function of the right. When she exercised her muscles, she was improving the function of her brain.
Ms. Riel
I am able to walk. I trained at the gym for handicapped people.
I speak French and English, which I knew before the surgery, but I since learned Spanish and I am working on Creole.
When I arrived to my apartment, it was like deliverance, at last I was "chez moi," at peace. I was finally at home. I had a lot of things to work through. It took a couple of years. I finished high school and went to secretarial, school. I can type 40 words a minute with one hand.
I am closer to my mother than my father. I have a couple of friends.
When I was 18, they approached me about taking part in research. They helped me, so I'm going to help them.
I met Dr. Olivier last year. I thanked him for saving my life. It was really that, I had no life. It was emotional for him too.
Dr. Olivier
We remain friends.
People with epilepsy, they know what trouble is, and it is good to see her living a full, independent life.