Another Brain Surgery

Graham Update Day 53 (7/31/14)

Late yesterday we were alerted that Neurosurgery here at Cook Children's had reviewed Graham's MRI and CT scans and wanted to speak to us about him.  Graham's neurologist told us this morning that Graham would "most likely need another surgery," but that neurosurgery would need to be the ones to talk to us as soon as they could get over, which happened at about 6:00 pm this evening.

It was a tough wait.  With everything that Graham has been through, another highly invasive brain surgery just seems like to much.  How many times does he have to get his skull torn apart? The thought of Graham going through that AGAIN, only this time more alert and aware, really weighs heavy on my heart.  How do would we explain these things to our now cognizant son?  It would be another mountain to climb, for sure.  Lindsey definitely put it best though - this is just another opportunity shore things up in his skull and set him up for success throughout his future.  She is such a strong and amazing woman and I feel so lucky to be married to her. 

Dr. Honeycutt here at Cook Children's is the neurosurgeon that we spoke with.  He said there are two things that need some attention: one very minor, and one very significant.  The minor issue is that Graham does not currently have a roof on his right orbital, which means the brain can, and is, sagging into that region of his head.  He said it doesn't pose any discernable risk, and fixing it only slightly increases his chances of regaining vision IF his optic nerve is the cause his right-eye blindness.  In other words, if this were the only issue, it wouldn't be worth operating on.  But it's not the only issue.

The real problem is Graham's sphenoid sinus, which I will do my best to identify in Graham's CT scan from Tuesday, here below:

The short of it is this - the impact of Graham's accident was so severe that it broke the base of his skull and despite attempts to seal the bottom portions of the dura (membrane around the brain), cerebrospinal fluid (CSF) is leaking into that "dirty" sphenoid sinus cavity.  And since fluid can get into that sinus, it means that the bacteria that lives therein has an open door back to the brain, putting Graham at risk for meningitis.  Untreated, Graham would essentially be playing a game of Russian Roulette with a deadly disease, every single day for the rest of his life.

Dr. Honeycutt here recommends performing a surgery next week, and he recommends it be performed by Dr. Braga - the man who performed Graham's first surgery.  He said that a plate will need to be placed over the sinus, and it will need to be sealed with tissue from inside the skull, similar to how they covered up Graham's frontal sinus in the first surgery.  If for some reason Dr. Braga can't do the surgery at Children's Medical Center, then Dr. Honeycutt will do it here at Cook Children's.

I asked Dr. Honeycutt how many times he had performed a surgery like this.  He said only a handful - rarely if ever does a patient actually receive an impact so strong that it fractures THE BASE of the skull.  The rarity of it sounds daunting, and it is, but then Graham's first surgery - reconstructing a forehead that had been sheered out of place in one piece - was a first for his brain surgeon and plastic surgeon then as well. 

I know Graham can overcome this.  He is the most amazing fighter I have ever met in my life.  But it pains me SO MUCH to think that he has to go through this.  Brain surgery coming out of a coma is one thing.  Brain surgery when you ate pizza, built Legos, and watched a movie the night before is another.  I often wonder if I have enough faith to merit the miracle Graham needs.  I wondered it often while listening to the beeping ICU monitors late at night in the days following Graham's accident.  It seems like a long time ago, but I remember being comforted then by the thought that even if my prayers and faith were not enough, the prayers and faith of so many others would be.  I lean heavy on that comfort now.  Thank you for praying for my son.  It gives me confidence that he really is in God's hands, and that Graham's burden will be made light by our loving Heavenly Father.