Keeler to undergo operation

Surgeon to insert tube to drain fluid from brain

Sun exclusive

June 18, 2007|By Liz F. Kay | Liz F. Kay,SUN REPORTER

Cardinal William H. Keeler is scheduled to undergo surgery this morning to remove excess fluid from his brain.

Dr. Ben Carson, a pediatric neurosurgeon, will insert a shunt, or tube, into the cardinal's brain to allow excess cerebrospinal fluid to drain into his abdomen, said Sean Caine, spokesman for the Archdiocese of Baltimore. The surgery is scheduled for 11 a.m. at Johns Hopkins Hospital.

Caine said the cardinal's physicians believe that head trauma Keeler suffered in a car accident in October might have triggered normal pressure hydrocephalus, or an abnormal accumulation of cerebrospinal fluid in the ventricles, or spaces within the brain.

"The potential effect of the surgery could render him in a much better position," Caine said.

Keeler, who broke an ankle and cracked several ribs in the accident while vacationing in Italy, resumed his normal activities soon afterward, leading services for the rededication of the Basilica of the Assumption in Baltimore in November and traveling to national meetings. He even attended a news conference last week at the John Paul II Center near Catholic University in Washington.

But he has been shuffling for several months, a symptom of hydroencephalus, Caine said.

The cardinal and Carson, who has performed similar procedures, declined to be interviewed before the surgery.

Keeler's accident last fall raised questions about whether Pope Benedict XVI would accelerate his appointment of a new archbishop of Baltimore.

The cardinal, who has served as archbishop for nearly two decades, submitted his resignation letter last year when he turned 75, as required by canon law. But he has not heard from the Vatican when it might be accepted.

At 76, Keeler is at the average age of most people diagnosed with normal pressure hydrocephalus.

Hydrocephalus, derived from Greek words meaning water and head, is probably best-known as a congenital disorder. The condition is found in one in 500 to 1,000 infants at birth, said Dr. Marvin Bergsneider, a neurosurgeon and director of the adult hydrocephalus program at UCLA, who has not been consulted on the Keeler case.

Normal pressure hydrocephalus was first recognized as a diagnosis in 1965 and is growing exponentially in the United States, Bergsneider said. "It could be more physicians are becoming aware" of the condition, he said.

Unlike infants with the condition, the heads of adults with normal pressure hydrocephalus do not swell or enlarge. But doctors can see ballooning of the brain's internal ventricles through an MRI or CT scan, Bergsneider said.

The swelling stretches the nerve fibers found in the middle of the brain that control leg movement and bladder function, he said.

Some patients, in addition to incontinence and problems walking, also experience some degree of short-term memory loss and even dementia if untreated, Bergsneider said. But the symptoms can go away with treatment.

"You shunt them, and you can bring them back to a very active life," Bergsneider said.

Surgeons drain excess fluid by inserting an adjustable shunt, a narrow tube with valves, into a ventricle on the right side of the brain. Bergsneider explained that language is controlled by the left side of the brain, and most people are left-brain dominant, so the right side is the best option.

The shunt is attached to a catheter that is threaded under the skin and through the neck to divert the fluid into a different part of the body, usually the abdomen, where the body reabsorbs it.

The surgical procedure takes about 25 to 30 minutes under general anesthesia, said Bergsneider, who described it as relatively straightforward.

Adjustable valves allow physicians to control the flow of the fluid externally, using a magnet. Patients can go home within a few days, and the valves are adjusted on an outpatient basis, he said.

"We start slowly and then gradually increase the flow until we get enough fluid draining until the patient improves," Bergsneider said.

The main risk is draining too much fluid, the surgeon said. The ventricles could collapse, creating space between the brain and the inside of the skull, where blood clots, called subdural hematomas, could form.

That's not the case with infants, whose developing brains adapt to the differing flow. "When you're dealing with a 76-year-old, you have to adjust with their brain," Bergsneider said.

The rise of adjustable valves has reduced subdural hematoma rates to 2 percent, from 15 percent, at UCLA. "We've had a lot more success than we did 10 to 15 years ago," he said.

And treatment could possibly help some individuals who might have chalked up short-term memory loss and problems walking to old age, Bergsneider said. A study of residents of nursing homes in Richmond, Va., this year revealed that 30 percent had trouble walking, incontinence and memory loss or dementia - all symptoms of normal pressure hydrocephalus.

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