5-inch aneurysm removed from Upper Marlboro teen

November 08, 1991|By Mary Knudson

Looking back, Norman's parents think the headaches were the first clues that something was wrong.

Norman Robinson Jr. was 10 then, living with his sister and parents in Upper Marlboro. The headaches were never severe, but sometimes bad enough to send him home from school. They continued for four years.

Then two months ago, he started shaking all over, felt very cold and developed a high fever. Mr. Robinson took his son to a nearby hospital, which referred him to Bethesda Naval Hospital.

Brain scans and other diagnostic tests revealed a large aneurysm, a ballooned-out blood vessel that was so large the Bethesda doctors scouted around for a surgeon skilled enough to remove it.

When the doctors told Williemae Robinson, Norman's mother, his diagnosis, she fainted away. "I found myself on the floor," she said.

The Bethesda doctors recommended Dr. Robert Spetzler, director of the Barrow Neurological Institute at St. Joseph's Hospital and Medical Center in Phoenix, Ariz.

The whole family flew out to Phoenix three weeks ago: Norman and Williemae Robinson, their son, Norman, 14, and his sister, Normelia, 16.

Dr. Spetzler has performed 1,000 operations on aneurysms of the brain, but never one like this. He found that the aneurysm was not only huge -- 5 inches around merging from the left frontal, parietal and temporal lobes in the front half of the brain -- but it was also unusually complex. Normally, he said in a telephone interview yesterday, an aneurysm only has a blood vessel leading into it. This one had a blood vessel leading into it and exiting from it. That meant the left side of Norman's brain depended on a blood supply that was dangerously routed through the bloated blood vessel.

Dr. Spetzler was amazed that Norman had made it this far.

The aneurysm could easily have burst, killing the youth or leaving him permanently impaired. Or the large bulge could have pressed on brain cells, causing serious symptoms such as difficulty walking or slurred speech. "I think he was born with a weakened wall [of the blood vessel], and this just progressively developed," the surgeon said.

The surgery at hand held two principal risks. During removal and repair of the aneurysm, the delicate cells of the brain that control such functions as speech, thought and movement, might be damaged. And blood vessels branching off the vessel that contained the aneurysm might be damaged, resulting in a blood clot that could cause a stroke.

The surgeon decided to proceed with two operations. Both were performed looking through a microscope with instruments inserted through a 3-inch hole in the left temple.

Before the advent of microsurgery some 17 years ago, this aneurysm would have been considered inoperable because of the size of the incision required and damaged blood vessels and brain cells caused simply by movement of the surgeon's hands, Dr. Spetzler said.

In the first operation Oct. 23, Dr. Spetzler disconnected the blood vessels coming out of the aneurysm and clipped the end of it to prevent the contents from flowing into the brain. But to keep blood supplied to the left side of the brain, he had to unhook a blood vessel from the scalp, swing it around and in through the opening made into the skull, connecting it so that it supplied blood to the brain.

In the second operation last Friday, the object was to get rid of the blood vessel leading into the aneurysm, but reaching it was a challenge. "The aneurysm was so large, it was like having to rotate a rock to get down to the other end," Dr. Spetzler said. He decided to cut it open and empty it. Then the blood clots were cut into pieces and sucked out.

"That gave us access to the blood vessel that was feeding it," he said. Then a metal clip could be inserted at the base of the aneurysm, preventing it from filling up again.

Dr. Spetzler said the aneurysm is the largest he had ever operated on and the largest he had ever seen in pictures.

Yesterday, Norman said his doctor "told me basically I had a big aneurysm and he wanted to take it out. He told me I shouldn't be afraid." And now, he's fine, thanks. A freshman at Riverdale Baptist School, he said he wants pizza, he wants to go outside tomorrow "and kiss the ground," and he wants to come home and go fishing with his dad.

By all reports, Norman remained stoic through his ordeal. "The power of God kept me going," he said.

Dr. Spetzler said the boy became his hero. "Norman is remarkable," Dr. Spetzler said. Through an array of uncomfortable tests and the two major surgeries, "he really didn't bat much of an eye. He has a sort of calmness and confidence that far exceeded his age. The fact that he was so confident gave us all an additional confirmation that we were doing the right thing."

"He's always been strong-minded," his mother said. "He's a determined young man. He had a dream when he was 5 years old. He said he had a conversation with Jesus Christ. He said 'Jesus had three boxes and asked me which one I wanted. I picked one box. He took the other two boxes back and went back up into the clouds. I opened the box and Moses was in the box and Moses helped me with my math problems.'

"Then he said, 'Mommy, I want to be a missionary. I want to help people. I want to tell people about God.' To this day he hasn't changed."

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