The risks of removing tumors and tree limbs
“Grey’s Anatomy,” ABC, Sept. 28.
The premise: Benjamin O’Leary (Peter Paige) is a patient with a tumor pressing on the frontal and temporal lobes of his brain. As a result, he is uninhibited, saying whatever comes into his mind, calling his sister “fat” and commenting on the sexual tensions between the doctors.
As Benjamin is being readied for brain surgery, 14-year-old Harly Hernandez is brought to the emergency room impaled on a large tree branch. Harly has sustained major damage to his kidney and intestines, and his father is told that his son has only a 60% chance of survival. After Harly’s organs are repaired, the large tree branch is removed in sections, and he lives. Benjamin, however, dies when his brain hemorrhages and swells during surgery.
The medical questions: Can pressure on the frontal and temporal lobes of the brain cause a patient to say outrageous things? Is it reversible with tumor removal? Is removing such a tumor likely to result in death? With impalement injuries, is removing the object best accomplished in pieces after the organs have been repaired and the bleeding has stopped?
The reality: The rapidly changing emotions and impulsiveness that Benjamin displayed is known as orbitofrontal syndrome, a common manifestation of brain tumors pressing on the frontal and temporal lobes.
In the episode, the surgeon is asked, “If the tumor is removed, is he going to get his old personality back?” The surgeon (Patrick Dempsey) replies, “If we get the tumor out and Benjamin lives, everything else will be icing on the cake.”
It’s not entirely wishful thinking, but by the time such tumors are removed, they have often permanently damaged that region of the brain. In the case of a benign tumor, the direct pressure on the brain or an interruption of its blood supply can cause some nerves to die. Successful surgery with tumor removal would most likely cause the behavior to diminish, but not disappear.
As for the survival rate, all brain surgery is risky, and swelling and bleeding are common complications. State-of-the-art stereotactic techniques using MRI mapping can reduce the risks. With that procedure, the surgeon wears a helmet that superimposes MRI images on the surgical field. Although hospital mortality from meningioma re-section has dropped -- as low as 1.8% in 2000, according to a nationwide sample -- the rate of complications increases with a difficult tumor location. In this episode, the location close to the cavernous sinus (behind the nose) makes a complication much more likely.
Impalement injuries, especially with sharp objects, carry a high risk of major-organ damage, as the abdominal cavity is tightly packed with organs. Although beginning a surgical procedure with the object protruding from the body may seem counterintuitive, it can make sense -- if the object is in a stable position. This allows doctors to immediately stop the bleeding and begin to suture the damaged organs before removing the object. Removing the object prematurely or all at once can risk further bleeding and organ damage.
Dr. Marc Siegel is an internist and an associate professor of medicine at New York University’s School of Medicine. He is also the author of “False Alarm: The Truth About the Epidemic of Fear.” In the Unreal World, he explains the medical facts behind the media fiction. He can be reached at marc@doctorsiegel.com.
