Doctors Don’t Expect Youth to Survive

As Steve Woods hovers on the brink of death, his neurosurgeon said Tuesday he holds little hope for recovery because the eight-inch metal paint-roller rod that pierced his skull caused damage deep in the region of the brain that controls the body’s basic life-sustaining functions.

Dr. Bruce Moffatt, the neurosurgeon who removed the rod from the youth’s skull at Mission Hospital Regional Medical Center emergency room Friday night, said, “My expectations are this will be an irreversible injury and probably not survivable.”

However, he added that the victim’s family is not yet willing to give up hope: “It is hard to give up on your son, your loved one,” he said.

The teen-ager has been in a deep coma since he and his friends were assaulted in cars following a football game, and Moffatt said there has been no improvement in his condition.

While Woods is not technically brain-dead, Moffatt said, “There is not much that separates him from being brain-dead, and that is why we are so pessimistic.”

Moffatt said the rod entered Woods’ head just above his right ear and continued at a slightly downward angle entirely through his head, where it was stopped only by the bone of his skull.

The path of the rod was captured on an X-ray before the instrument was carefully extracted. “It was straight and blunt and slid right out,” Moffatt recalled.

However, he added, serious harm was already done. The rod plunged through the right temporal lobe of the brain, which controls memory, vision and hearing, he said, and then into the cerebellum, a serrated cauliflower-shaped portion that controls muscular coordination, balance and posture.

But most unfortunately, Moffatt said, the rod then entered the backside of the brain stem, doing irreversible damage to this small but vital brain center that controls blood pressure, pulse, breathing and consciousness.

“Right now 90% of the brain stem is not working,” Moffatt said.

According to The American Medical Assn. Encyclopedia of Medicine, the cerebellum and brain stem are the oldest in evolutionary terms and their structure and function are similar in humans and other mammals.

Both brain regions operate below the level of consciousness by reflex action. They receive sensory information about temperature, pressure or pain from sensory receptors scattered throughout the body and then transmit the appropriate response, for instance by prompting muscles in blood vessels to change blood pressure.

“Usually, once there is damage of this severity to the brain stem it is permanent,” said Moffatt, who is president of the Society of Neurosurgeons of Orange County. He said while larger parts of the brain can sometimes compensate for damage, the brain stem is much less forgiving because “a lot of information and control is packed into a very small area.”

He added, “It is unimportant if all the rest of the brain is functioning if you don’t have a functioning brain stem. If it (the rod) hadn’t injured the brain stem directly, the outcome might have been somewhat better.”

Dr. John Neal, assistant professor and acting chairman of the department of neurological surgery at UC Irvine, said the history of injuries to the brain is a long one, including reports of violations by all kinds of objects, from chopsticks, knitting needles and axes to railroad spikes.

The outcome, he said, has a lot to do with what part of the brain is harmed and the physicians’ ability to prevent secondary problems, such as infection.

Dr. Robert Wayner, vice president of the local society of neurosurgeons, agreed on the significance of the brain stem, comparing it to telephone communication in an office building. “If there is damage to that area, you are not just cutting one telephone wire, you are cutting the whole cable coming into the building,” he said.

In Woods’ case, Moffatt said, “what is still working is just the very base of the brain stem that has to do with swallowing and maybe some respiration.”

It is uncertain whether Woods can breath on his own, Moffatt said, because he is being maintained on a respirator. Moffatt said the youth also is being treated with a variety of medications to reduce brain swelling, prevent infection and control his blood pressure. A tube has been inserted into his brain to drain off excess spinal fluid that could cause brain-damaging pressure.

“Basically, we are providing as normal an environment as possible for the brain to recover on its own, if possible,” he said.

Moffatt said, however, that in his judgment, that possibility is highly remote. He said nonetheless that Kathy Woods, the injured youth’s mother, “understandably does not want us to give up” and so doctors are continuing to do their best.

Before life support is withdrawn, he said, “we hope to come to a collective decision.”

Times staff writer Rebecca Trounson contributed to this report.

Wood’s Brain Damage

The metal rod that pierced the skull of Stephen Wood caused severe damage to parts of the brain that control life-sustaining functions. What was damaged:

The Rod’s Path

1) Entered skull above right ear through the temporal lobe

2) Pierced cerebellum, brain stem

3) Stopped by skull bone on other side of head

Temporal lobe: Controls memory, vision, hearing

Cerebellum: Controls balance, posture, coordination

Brain stem: Controls breathing, blood pressure, consciousness

Sources: Dr. Bruce Moffatt, World Book Encyclopedia

Researched by CAROLINE LEMKE / Los Angeles Times