High-tech surgery planning helps toddler thrive
By Christina Orlovsky Page
At 17 months old, Reef Whittemore is walking, talking and living a happy, mellow and carefree life with his dad, Robe, mom Meridith and big sister Brighton. But life was anything but carefree back in May 2014, when Meridith, 37 weeks pregnant with Reef, was feeling unusually uncomfortable.
“At 32 weeks, I had been having bad Braxton Hicks contractions, so I went in for an ultrasound,”Meridith recalls. “The baby was big and I was really uncomfortable, so we went in again at 37 weeks for a follow-up. At that point my only fear was that I would have to have a cesarean section because the baby’s head was so big!”
What happened next sent the Whittemore family into a frenzy: Doctors discovered an abnormal collection of blood in the baby’s brain and insisted Meridith get to the hospital immediately.
“It was the scariest 48 hours of my life because I didn’t even know if he was going to survive in my stomach for the next day or so while they scheduled the C-section,” she says. She adds that she’s thankful she listened to her body — and mother’s intuition — and visited the doctor that day. “Thank goodness I was so uncomfortable because he definitely was trying to tell me something.”
Reef Makai Buttons Whittemore was born via emergency C-section at Sharp Mary Birch Hospital for Women and Newborns on May 8, 2014, just three days before Mother’s Day. Immediately, he was whisked away from his mother through the tunnel connecting Sharp and Rady Children’s Hospital-San Diego and admitted to the neonatal intensive care unit (NICU), where he would be treated for respiratory distress before doctors determined the next course of action.
“Reef was stabilized in the NICU for several days while the neurosurgical team considered the best operative approach,” says Denise Suttner, M.D., attending neonatologist at Rady Children’s and a clinical professor at UC San Diego. “The other conditions he experienced are very common and straightforward; they were minor issues compared to the fact that he had a very large vascular lesion on his brain.”
Condition critical Reef was diagnosed with a massive aneurysm, a weak spot on a blood vessel that balloons out and fills with blood. A brain aneurysm can rupture and bleed into the brain, which can be fatal.
“Giant aneurysms in infants are extraordinarily rare and extremely dangerous,” says Michael Levy, M.D., Ph.D., chief of the division of neurosurgery at Rady Children’s and a professor at UC San Diego. “When one occurs, the blood is running so rapidly that it is hurting the rest of the brain, so you want to remove it very quickly before it ruptures.”
While the Rady Children’s neurological team consulted with physicians across the country to devise the best possible plan of attack for Reef’s aneurysm, Robe Whittemore was busy recording conversations with doctors and nurses in order to be able to accurately relay to his wife in the neighboring hospital what was going on with their son.
“There were so many questions about what was going to happen, but our doctors—especially Dr. Suttner and Dr. Levy—really put us at ease,” Robe says. “The nurses would all visit Reef in the NICU because he’d smile and react to them—he was smiling through it all! At the time, we realized that our child was in a life-threatening situation, but the people who were working on him made us feel so good.”
Dr. Levy prepared for the surgery using 3-D virtual models of Reef’s unique blood vessels in order to develop a precise understanding of his vascular system — a technique that appealed to the practice-makes-perfect mentality of Robe, a firefighter.
“Dr. Levy explained that he had re-created Reef’s blood vessels on a computer program and had performed the surgery many times prior to even touching our child’s head,” Robe recalls. “As a captain on a fire engine, I am trained to go over things until they become muscle memory. Technology today is so amazing that Dr. Levy was able to do that with Reef’s surgery so that when he actually performed it, nothing was unexpected or abnormal.”
In fact, everything went so smoothly with the surgery that Reef’s physicians expect no long-term effects from the aneurysm.
As his proud dad puts it, “He’ll be a normal kid with a horseshoe scar and a story to tell.”
Story time will come later, but for now, life’s a beach for Reef and his family in Point Loma, where the toddler loves surfing and paddle boarding with his dad, wrestling, eating, dancing, and just being a happy little boy.
“There’s nothing that’s going to hold him back,” Robe says. “He’s good to go.”
Perfecting the procedure: 3-D modeling
With any performance, whether it’s at the theater or in the operating room, practice makes perfect. Thanks to groundbreaking technology, practice is available to some of the most skilled performers in the world: neurosurgeons.
The SuRgical Planner,™ created by the company Surgical Theater, allows surgeons to rehearse procedures to perfection. Dr. Michael Levy used the technology to prepare for surgery on Reef’s aneurysm — a case in which precision was of the utmost importance.
“Using a patient’s CT or MRI data, you construct a 3-D model of the vascular system to analyze anatomically where the blood is going in and out,” Dr. Levy explains. “In procedures like this, there’s no room for blood loss, so you practice in order to develop an understanding of what you’re dealing with, and you keep going through it until you are certain about the anatomy.”
According to Dr. Levy, Rady Children’s is the first hospital to utilize 3-D modeling for pediatric neurosurgery. “It’s a brand-new technology that people are assessing, and thus far, we are the only ones that have tested its utility with kids,” he says. “I think it’s extraordinarily useful in making things safer and easier.”
Originally published in The San Diego Union-Tribune, October 2015