Spring 2011 Issue

From Trauma To Triumph
Providing Lifesaving Neurosurgical Care

Every trauma case is a race against time. Arriving at the best outcome possible requires not only specialized medical expertise, but also the highest level of teamwork and professionalism from the first responders to the hospital and surgical staff. The neurosurgeons of Carolina Neurosurgery & Spine Associates are proud to play a vital role in treating trauma patients in this region. Following are two different patient profiles about two young boys, each illustrating how all the pieces came together to result in triumph over tragedy.

Devastating Joyride Followed By A Remarkable Recovery
On July 3, 2010, Kevin Luna, an active and healthy 11-year-old, decided to go for a joyride in a golf cart with his nine-year-old brother near their home in Huntersville. As they rode through a parking lot, Kevin tried to drive the cart beneath a parked tractor-trailer. Unfortunately, he misjudged the height and the trailer caught him flush in the forehead. The blow knocked him unconscious and fractured his skull and facial bones. The coverings of both frontal lobes of the brain were torn and the underlying brain was severely bruised. Luckily, his shorter brother was uninjured.

The EMT first responders immediately recognized the magnitude of Kevin’s injuries and took him directly to the local emergency department, where his airway was secured with an endotracheal tube. He was then airlifted to the Trauma Center at Levine Children’s Hospital in Charlotte. His injuries were evaluated and stabilized by the pediatric subspecialty physicians there, including neurosurgeon Scott McLanahan, MD, of Carolina Neurosurgery & Spine Associates.

“The greatest danger for Kevin was the possibility of uncontrollable brain swelling,” said Dr. McLanahan. For
that reason, and because Kevin remained unconscious, Dr. McLanahan inserted an intracranial pressure monitor to assist in the measurement and management of that swelling.

Scott McLanahan, MD
This was the 10,000th surgical procedure that Dr. Scott McLanahan has performed since joining Carolina Neurosurgery & Spine Associates in 1980. He is fellowship-trained in pediatric neurosurgery and is a director on the American Board of Pediatric Neurological Surgery.
Two days following his injury, Kevin was stable enough to undergo a four-hour surgical repair of his injuries, a procedure requiring the skills of both Dr. McLanahan and a plastic surgeon, Stan Getz, MD. Dr. McLanahan focused on limiting further injuries to Kevin’s frontal lobes and repairing the coverings of the brain, while Dr. Getz concentrated on repairing Kevin’s cranial and facial fractures.

Concerns regarding brain swelling postoperatively were managed by draining fluid away from Kevin’s brain. Following surgery, while his wounds were healing, Kevin remained unconscious. Over the next three weeks, there was a real concern among his physicians and family that Kevin may have suffered an irreparable injury that would leave him with serious neurological impairments. Still unconscious, Kevin was transferred to the Pediatric Rehabilitation Unit at Levine Children’s Hospital, where an intensive agenda of rehabilitative therapies was initiated.

One month after his devastating injuries, Kevin regained consciousness and was able to actively participate in his therapies. Since that time, his progress has been nothing short of phenomenal. Those closest to him say they can’t differentiate him from the “old” Kevin. He is back in school and performing well. His physical impairments are minimal and even those are gradually disappearing.

“Kevin’s story further illustrates the exceptional level of care that is available to the children of our region,” said Dr. McLanahan. “The prompt response to his injuries and the expertise at our disposal significantly increased his chances for recovery.”

Every Second Counts With An Epidural Hematoma
When four-year-old Colin fell and hit his head during a weekend birthday party, the fall seemed no worse than the typical bumps and tumbles that kids routinely experience. However, within a few hours, his condition began to escalate with an intense headache and nausea. His parents decided to take him to the hospital as a precaution. While in the car, Colin started screaming in pain and began to lose consciousness. As this happened, they were passing the North Mecklenburg Volunteer Rescue Station. Colin’s father pulled in to get immediate help. Volunteers on duty administered oxygen and called for an ambulance, which transported Colin directly to Carolinas Medical Center in Charlotte.

Click on the video above to see a re-enactment of Colin’s story.
When Colin arrived at the ER, he was assessed by the attending trauma physician, Michael Thomason, MD, FACS, and by Emily Tucker, NP, a nurse practitioner with Carolina Neurosurgery & Spine Associates. Colin was slipping in and out of consciousness but was communicating with his mother. Emily ordered an urgent CT scan and put the OR on alert.

“The CT scan uncovered a 2.5 cm epidural hematoma,” said Emily. “I immediately called neurosurgeon Craig VanDerVeer, MD, at home and told him to get here right away.” Emily then sprinted to the OR with Colin. She instructed the anesthesiologist to hyperventilate Colin and give him 3% saline. Mannitol was administered to reduce intracranial pressure. Emily then prepared Colin for surgery; every second was critical.

Dr. VanDerVeer arrived, and Emily assisted with the two-hour surgery. They found that Colin’s epidural hematoma had almost doubled in size in a span of only 10 minutes. Colin was going to be all right. Only one day after lifesaving surgery, he was playing videos games in the hospital and was able to go home two days later.

To learn more about the trauma or pediatric services offered by Carolina Neurosurgery & Spine Associates, call 800-344-6716.

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