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Bolt drilled through a skull is rescuing patients with brain injuries


Dr. Mypinder Sekhon demonstrates catheters and the new brain bolt that were used in a life-saving procedure at VGH in Vancouver, BC, Jan. 16, 2019.


Arlen Redekop / PNG

Brad Baylis doesn’t remember anything about the day last summer when he hit a moose while driving in northern B.C.

Indeed, everything the Prince George man knows about his close brush with death — not to mention the entire month afterward — he’s pieced together from friends, family and medical professionals who saved his life after the moose crashed through his windshield, sending Baylis careening into a ditch and trapped in his vehicle.

Baylis, 39, and the moose would be extricated from the vehicle and he would be airlifted to Vancouver General Hospital on life support. While he was in the intensive-care unit for a month, plastic surgeons would spend 10 hours perfectly reconstructing his shattered face and intensive-care specialists would make Baylis the first patient to get a new procedure called brain microdialysis.


Undated handout photo of Bradley Baylis and girlfriend Carla Lewis. Bradley Baylis of Prince George hit a moose near Fraser lake in 2018.

Nikola Bennett /

PNG

With Baylis on the verge of dying from his traumatic brain injury, Dr. Mypinder Sekhon and colleagues deployed newly acquired tools that allowed them to frequently monitor Baylis’s brain-tissue chemistry so they could tailor the amount of glucose and other metabolic supplements he needed intravenously. They were also able to do real-time monitoring of oxygen and blood-pressure levels in his brain to deliver medications with doses tailored to his condition rather than giving standardized doses.

“The impact with the moose caused major hemorrhaging in his brain and he was suffocating from a lack of oxygen while emergency crews were extricating him from the vehicle,” said Sekhon. “It was a horrible, horrible injury with diffuse swelling throughout his brain. Often with this kind of swelling, brain death will ensue. We had no option other than to try the bolt.”

The lumen (hollowed-out) bolt and accompanying disposable instruments are medical devices developed and manufactured by a Swedish company and, until recently, used mainly in research settings at Cambridge University in the U.K.

Neurologists drill a one-centimetre hole into the skull to place the bolt, which then allows doctors to pass a catheter through it so they can collect and analyze biochemical markers of brain activity (glucose, lactate and glutamate, among them).


Undated handout photo of Bradley Baylis in VGH.

Nikola Bennett /

PNG

The data is fed into an analyzer that gives a digital reading and then medical teams can adjust the amount of oxygen, glucose and nutrients that comatose and other brain-injured patients need to not only recover, but also to avoid permanent disabilities.

“It’s changed the way we prognosticate,” said Sekhon. “We can get a better idea of the disease process inside a patient’s brain. Before this, we would fly blind, essentially. You can give too much glucose and other supplements or not enough. Using this technique, we are now able to optimize the brain’s metabolism and personalize the care of the patient.”

Drilling holes into patients’ skulls is an admittedly invasive procedure that carries a small (0.5-per-cent) risk of infection or bleeding, but at VGH, microdialysis has been used so far on five patients, including Baylis (in the past five months), and four of them have recovered. (The fifth succumbed to the brain injury.)

After being in the ICU for a month, Baylis was then transferred to G.F. Strong for rehabilitation. He is overcome with emotion when he talks about the physical therapists there who helped him walk again, his girlfriend Carla Lewis, family members and doctors like Sekhon — all of whom “never gave up on me.”

While he hasn’t yet been cleared to return to his job as a welder, the father of three is incredulous that he’s been able to almost completely recover from a brain injury as severe as the one he had.


Dr. Mypinder Sekhon demonstrates catheters and the new brain bolt that were used in a life-saving procedure at VGH in Vancouver, BC, Jan. 16, 2019.

Arlen Redekop /

PNG

He hasn’t yet resumed driving and he’s in no rush to get back behind the wheel. When he got out of G.F. Strong a few months ago, he took the Northern Health bus back to Prince George and it was a trip that could have been terrifying and traumatizing but Baylis managed to take it in stride:

“During the latter part of the trip, the bus driver had to slam on the brakes to avoid hitting a moose. When you live in this area, you know this sort of thing is going to happen at some point. I don’t know if this last incident was luck or fate, but you have to respect moose, they are amazing animals.”

Sekhon says that when Baylis was airlifted to VGH he thought Baylis had only a 10-per-cent chance of surviving. But after a week, he came out of the coma and credits the new microdialysis tools for making the difference with his recovery. While the microdialysis tools are insanely expensive — startup costs of up to $500,000, then costs of up to $10,000 each time the suite of tools are used on patients — they would appear to be true lifesavers.

VGH is the only hospital in Canada using the microdialysis protocol and one of only a handful of hospitals around the world using it. A hospital in Calgary tried it for a while, but Sekhon said it became too expensive so it was abandoned. At VGH, donors to the hospital’s foundation covered initial acquisition fees, but now the costs are absorbed into the hospital’s annual operating budget.

Only in the last few years have specialists like Sekhon had access to tools that allow them to individualize treatment plans for patients. In 2016, Sekhon and colleagues were recognized for using brain-monitoring technology that helped salvage the neurological functions of a world-renowned freestyle skier after she crashed during an international competition. In that case, doctors drilled a hole into the skull of the 22-year old patient — Jamie Crane-Mauzy — so they could take real-time measurements of oxygen and blood-pressure levels in her brain, which enabled them to tailor medications and other interventions to her condition.

Sekhon estimates VGH will receive 20-30 patients each year who will benefit from microdialysis and other brain-monitoring. The hospital has developed a specialized neurocritical-care program consisting of neurosurgeons and intensive-care specialists so that patients with severe brain injuries can get such advanced brain-monitoring, increasing their chances of recovery.

A study published last year that tracked 113 patients with severe brain injuries showed that those who got care from the specialized team were 2.5 times more likely to have a full neurological recovery after six months.

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