Reagan Has Surgery for Fluid on Brain

Former President Ronald Reagan underwent “successful” surgery Friday in Rochester, Minn., to drain a “collection of old blood” on his brain, apparently the result of his horseback riding accident two months ago, a spokesman said.

“President Reagan is conscious and recovering in his room, where he is comfortable and in good spirits,” Reagan spokesman Mark Weinberg said shortly after the operation. He added that the surgery, which lasted slightly more than an hour, was “without complications.”

The buildup of blood and other fluids between the membranes that separate the brain and the skull is known as a chronic subdural hematoma. It was found during a “routine physical examination” at the Mayo Clinic, where the 78-year-old Reagan and his wife, Nancy, frequently receive medical care, Weinberg said in a written statement.

Routine Procedure

Although Reagan had not experienced any symptoms, his physicians recommended that the fluid, on the top of the right side of his brain, be removed in a routine procedure at St. Marys Hospital, a Mayo Foundation Hospital, Weinberg said.

“President Reagan’s care is being managed by a team of physicians and nurses from the Mayo Clinic who are completely satisfied with the result of today’s procedure and with President Reagan’s recuperation thus far,” Weinberg added. He said that although “no further treatment is anticipated,” Reagan will be “carefully monitored.”

President Bush, returning to Washington aboard Air Force One from New Orleans, told reporters “I hope it’s all right--pray it’s all right.”

The relatively common neurosurgical procedure is performed under general anesthesia. It consists of drilling small holes about the size of a dime, known as “burr holes,” through the skull and drawing out the fluid by putting a tube through the burr hole and sucking it out with a syringe.

Typically, one to three burr holes may be required and between four and 12 ounces of fluid may be removed. In Reagan’s case, one burr hole was apparently required.

Neurosurgeons not connected with the case said the operation was usually successful for patients with the former President’s condition.

Dr. Lawrence H. Pitts, chairman of neurosurgery at San Francisco General Hospital, said the technique was “a fairly straightforward procedure.”

“In the vast majority of cases, all of the fluid can be extracted just through the burr holes,” said Dr. Neil A. Martin of the UCLA Medical Center. Making a burr hole “does not involve any great risks to the brain or its blood supply.”

Martin said that patients typically remained in the hospital for about a week and then continued to recuperate for at least several weeks outside the hospital. The “great majority” of patients recover fully, he said.

The holes in the the skull are not patched, but fill with scar tissue. A small indentation of the scalp may result, but significant cosmetic problems are unusual.

Potential complications include heart or lung problems related to the surgery and anesthesia and, rarely, infections. In addition, in about 10% of cases, the fluid reaccumulates, Martin said.

Chronic subdural hematomas contain blood and decayed blood cells. They are the long-term result of bleeding on the surface of the brain from veins that are damaged by head trauma. The hematomas may occur at any age, but are most likely to develop in infants and the elderly, whose blood vessels may be more fragile.

The initial bump on the head may be relatively minor but fluid can continue to accumulate after the actual bleeding stops. This is because the concentration of blood and its breakdown products can attract fluids from surrounding tissues.

If a sufficient amount of fluid accumulates, symptoms such as headaches, difficulty in walking, seizures or weakness of an arm or leg can develop. More severe head trauma may cause symptoms to develop within days or weeks of the injury.

Reagan, a riding enthusiast, suffered bruises and scrapes July 4 when he was thrown from a bucking horse on a rocky downhill slope at a friend’s ranch in the Mexican state of Sonora. At the time, news reports made no specific mention of head injuries.

After the accident, Reagan was flown by helicopter to an Army hospital in Arizona, where physicians examined him, took X-rays, and pronounced him in excellent condition. After the examination, Reagan returned to the ranch to continue his vacation, against the advice of physicians who suggested that he remain at the hospital overnight.

The Reagans, who live in Los Angeles, arrived in Rochester Wednesday evening and both underwent routine medical check-ups Thursday. Weinberg said that aside from the former President’s hematoma, the Mayo Clinic physicians found the Reagans are “in excellent health.”

Weinberg’s statements about Reagan’s illness did not indicate what tests were performed to diagnose the subdural hematoma. Usually this abnormality is diagnosed with a CT scan or an MRI scan, special radiological techniques to examine internal structures of the body.

The statements also did not indicate why Reagan had undergone tests that might diagnose a brain problem if he was not experiencing symptoms. In addition, the spokesman did not indicate if worrisome abnormalities had been detected during his check-up. For example, when physicians examined the blood vessels in the back of the eye, they might have detected a swelling known as “papilledema” that may indicate high pressure within the skull.

Many physicians do not recommend tests such as a CT scan of the brain for asymptomatic patients. “If somebody is having headaches, that is one thing,” Martin said. “But a CT scan is not part of a routine physical examination.”

Reagan had a series of health problems during the eight years he served as the nation’s chief executive, including surgery for colon cancer in July, 1985, and surgery for an enlarged prostate in January, 1987. In March, 1981, he was shot in the chest in an attempt on his life. He underwent three hours of emergency surgery at George Washington University Hospital in Washington,

REAGAN’S BRAIN SURGERY: Former President Ronald Reagan underwent what a spokesman described as successful surgery Friday to drain a chronic subdural hematoma. The condition apparently resulted from the 78-year-old Reagan’s horseback riding accident in July.

The subdural hematoma is a build-up of blood and fluid beneath the dura mater, the fiber-like outermost layer of the membranes that surround the brain and spinal cord. The corrective surgery consists of drilling small holes about the size of a dime through the skull and draining the fluid.