Sticky Situation:By: Andrew Nilsen - Houstonia Magazine
When Glue Fixes a Brain and Saves a Life
Sandy and Mark Lackey hate to think what would have happened to their daughter if the ambulance had not made the long drive to Children’s Memorial Hermann Hospital.
Mark remembers feeling impatient, expecting their daughter Lauren to be rushed to the nearest facility in Cy-Fair, or to Texas Children’s, if she needed specialized care. Instead, he recalls, “The ambulance driver was very calm and said, ‘We’re going to Children’s Memorial Hermann.’ And thank God he did.”
On that Wednesday morning, a very rare brain condition caused fourth-grader Lauren Lackey to slip into a coma. She had complained of dizziness to the school nurse, who called Mark and recommended she be taken to a doctor. By the time he arrived, Lauren was unaware of her surroundings and could barely walk. Recognizing that something was very wrong, he called 9-1-1, and the EMT specialists sped Lauren to Children’s Memorial Hermann Hospital, where neurosurgeon Dr. Peng Roc Chen saved her life.
Sandy Lackey, an intermediate-school teacher in Tomball, was in the middle of teaching a lesson when she was notified that her daughter was on the way to Children’s Memorial Hermann Hospital. At the time, she thought Lauren must have had some sort of brain clot. When she told her students she had to leave unexpectedly and was bombarded with questions, Sandy, wanting to shield them from fear, said, “Lauren fell on the playground.” In a further effort to remain calm in front of her students and colleagues, she declined offers of company and drove herself to the Texas Medical Center as quickly as safety would allow.
Did You Know?
A cerebral angiogram is a special X-ray that allows doctors to look at blood vessels.
Lauren’s MRI indicated that she suffered from occlusions in a venal sinus, along with a dural arteriovenous fistula. Mark and Sandy met with pediatric neurosurgeon Dr. James Baumgartner, who informed them that one of the nation’s foremost cerebrovascular neurosurgeons, Dr. Chen, would be called in to treat Lauren the following morning. The Lackeys spent the night near their daughter in the Pediatric Intensive Care Unit.
Dr. Chen, who is affiliated with the Memorial Hermann Mischer Neuroscience Institute, remembers being alerted to the situation that morning, right before his workday began. He made the necessary schedule rearrangements and went directly to Children’s Memorial Hermann, where he was immediately able to assess “90 percent of the problem” by examining Lauren’s MRI results, although he knew he would need to perform an investigative procedure, cerebral angiography, in order to understand the full extent of the problem. Lauren’s brain was so swollen and pressurized, however, conventional open surgery meant risking a dangerous hemorrhage. Instead, Dr. Chen and his team employed a procedure known as endovascular exploration, using a catheter inserted through the groin to reach the site of the problem in her head.
It was via this method that Dr. Chen discovered that Lauren suffered from occlusions in almost all of her venous sinuses, blocking major vein passages. He likened the girl’s condition to a traffic jam in which an eight-lane freeway is suddenly narrowed to one lane. Blood was gathering faster than the unblocked veins could disperse it.
Lauren’s occlusions were further complicated by the formation of a diffuse dural arteriovenous fistula (DAVF), an abnormal connection between veins and arteries near the brain that can occur with no apparent cause, as in Lauren’s case. When the body is functioning normally, arterial blood is pumped from the heart to the brain’s arteries, then capillaries, distributing oxygen and nutrients to brain cells before exiting back to the heart through the veins. In a DAVF, however, arteries from the scalp and skull are wrongly connected to the veins that normally drain blood from the brain, causing significant elevation of intracranial pressure and brain swelling. In Lauren’s case, the DAVF combined with the vein occlusions represented a critical injury, one putting her in seizure and at risk for permanent memory loss, blindness, brain damage, or even death.
As information was being gathered from the cerebral angiography, a neurosurgeon sat with Mark and Sandy, explaining their daughter’s condition and possible options for treatment. Sandy remembers well the metaphor “swimming with sharks” echoing in her head because her daughter was in dangerous waters, and she froze with fear when Dr. Chen emerged from the operating room.
“I know what to do,” he said simply, before explaining a detailed plan of attack to the Lackeys, carefully and patiently enumerating potential risks. Among Dr. Chen’s requests was that the family plan for a long stay at Children’s Memorial Hermann. The Lackeys prayed for the best while bracing themselves for the worst.
Dr. Chen’s immediate task was to perform endovascular surgery to seal off the arterial malformations that were pumping blood into Lauren’s brain and threatening her life. (Her brain was in a state of constant seizure by this point.) Because of the risk of hemorrhage, however, Dr. Chen was once more forced to use a nontraditional approach. He would use a catheter to go back into Lauren’s brain and then seal the malformations with Onyx, a glue developed to seal DAVFs and other arteriovenous malformations.
DAVFs such as Lauren’s are rare—there are only about one or two incidences of the condition in adults per 100,000 persons each year and even fewer among children. Fortunately, Dr. Chen has experience using Onyx to treat DAVF in both adults and children, with his youngest patient being just two days old. He knows the challenges this procedure entails: applying the rapid-drying sealant in a timely manner without overfilling the malformations and further damaging the patient’s circulatory system.
Dr. Chen operated on Lauren for four hours that Thursday and five hours the following day. The procedure was a success, resulting in the complete sealing of all malfunctioning vessels and a restoration of blood flow to normal levels. Lauren’s brain seizures stopped, and she emerged from her coma.
Did You Know?
The symptoms of DAVF can range from headache and ringing in the ears to stroke and seizure.
In his role as a cerebrovascular neurosurgeon, it is not unusual for Dr. Chen to be called on short notice to perform lengthy emergency surgeries. He has years of experience, working with leading US hospitals and performing nationally published research in the field. He joined the Memorial Hermann family in 2008 and is now the Director of the Cerebrovascular Endovascular Fellowship Program at the Mischer Neuroscience Institute, describing himself as a lover of new challenges and cutting-edge medical exploration. He accepted the position, he says, because it was Memorial Hermann that promised to offer him the greatest support. In addition, Dr. Chen teaches at McGovern Medical School at UTHealth, thereby ensuring that his skills and experience are available to future doctors as well as to patients like Lauren.
The Saturday after her hospital admission, Lauren woke from anesthesia to the sight of her parents’ smiles. Sandy and Mark’s expected six-week stay at the hospital ended up lasting only two weeks, during which time they were supported by a parade of friends, family members, and their parish priest. And while the hospital had numerous patient-relations professionals at the ready, Mark and Sandy were kept apprised of Lauren’s condition by Dr. Chen himself, as well as the other doctors who worked to save her. Sandy remembers all of them—pediatric neurologist Dr. Ian Butler, the hematologist, the occupational and physical therapists, all of whom took pains to explain their roles and procedures. She is amazed even now at how “all the teams on Lauren’s case worked so well together.” Mark, meanwhile, still marvels at the precise coordination of the medical professionals involved and the daily conference calls they held to plan their efforts.
Others who left lasting impressions on the Lackeys included the nurses who stayed by their side through the long days of Lauren’s hospitalization. Indeed, Sandy’s eyes mist as she recalls their patience and compassion. Today, she thinks of that two-week stay as a “strange bubble of time” that changed her life, one that began with her worst fears and ended with relief and gratitude.
Upon her release from the hospital, Lauren was put on a regimen of blood thinners and medication that she still takes daily to maintain her normalized condition. She and her parents continue to consult with Dr. Chen and his clinical assistant, Callie Bynum, along with the other staff at Children’s Memorial Herman Hospital, and now know what signs to watch for to prevent future occurrences. Sandy feels comforted by the resources on call, “to know that we do have that support.”
When asked about her experience, Lauren recalls only feeling dizzy on the way to the school nurse’s office, then waking up that Saturday at Children’s Memorial Hermann Hospital. No one would guess by looking at her what an ordeal she suffered. Bright and fit, she is an honor roll student and dancer, and seems content to let the novelty of being “the girl with glue in her brain” fade and to return to normal life. At the same time, she expresses a desire to be a resource and inspiration to other children who experience similar maladies.
“We call her our little miracle,” Mark says of his daughter, who continues to outpace even her doctors’ most optimistic prognoses. “We couldn’t have asked for it to come out any better,” he says, adding that he’ll never stop being thankful for the ambulance that first brought Lauren to Children’s Memorial Hermann Hospital, however long and unexpected the ride was.