Rutgers • Robert Wood Johnson Medicine • Fall 2015 Page 13

Robert Wood Johnson

MEDICINE 11

The first step was sealing the blood vessel shut, with what

Dr. Roychowdhury calls "brain glue." He and neurosurgeon
Gaurav Gupta, MD, assistant professor of surgery at the
medical school, inserted a catheter through an artery in
Christina's leg, guided it past her heart and through the
carotid artery in her neck, and positioned it at the site of the

bleed. "It's almost the same as Krazy Glue," Dr.
Roychowdhury says. "If you pour it on your fingers, you

will make them stick together. With a microcatheter we
injected the glue, and we were able to shut the bleeding
down."

Pediatric neurosurgeon Rachana Tyagi, MD, assistant

professor of surgery and director,
pediatric neurosurgery, then led a
team that removed part of
Christina's skull to prevent fur-
ther damage as her brain tried to
heal. "The pressure from the
swelling can cause secondary
damage to additional areas of the
brain," says Dr. Tyagi. "We gave
her brain space."

Christina emerged from sur-

gery still in a coma, which would
last for nine days. When
Christina woke up in the pedi-
atric intensive care unit, her
mother says, "It was `Oh my
God--she recognizes me and she
can speak.' One of the first things
she asked for was her phone, so I
knew things were happening in
that brain, that this is my child and I'm getting her back."

Christina remembers none of this--in fact, everything is

a blank from when she had the headache in the car until
she was in rehab hoping to recover the use of the left side
of her body. But she remembers very well what she now
considers the turning point in her recovery--just a month
after her stroke, when she began to walk.

"I really pushed myself because I wanted to get out of

there," Christina says of the strenuous rehab sessions that
began just days after she awakened. "I wanted to get out
by my birthday, August 31, and I made it, one day before."

Soon she resumed her ninth-grade schoolwork at home,

wearing a helmet to protect the area where the portion of her
skull was still missing. She stayed mostly indoors for a few
months, because "I didn't want to be seen that way." She
also set another deadline, this time for the medical team.

"We had to have her major treatment items done before
Christmas," Dr. Tyagi recalls. "It was very important to
her."

That meant reattaching the piece of skull and also per-

forming a delicate procedure designed to eliminate all ves-
tiges of the AVM, so it could never rupture and bleed again.

For that, Dr. Tyagi enlisted Atif Khan, MD, associate pro-

fessor of radiation oncology, whose specialty is using a
device called a Gamma Knife that destroys malignant cells
with radiation. It was Dr. Khan's job to demolish Christina's

abnormal blood vessels. Guided by imaging technology, Dr.
Tyagi showed Dr. Khan which delicate structures of the

brain he needed to avoid, and he
did the rest.

"We used headgear t hat

resembles the ladies who used to
sit under the drying machines
with curlers in their hair," says
Dr. Tyagi. "Imagine that the
curlers can shoot. You choose
angles from which brain tissue
won't be damaged, and then
shoot multiple beams to deliver
a high dose to the spot you want
with submillimeter accuracy."

As recently as 10 years ago,

says Dr. Tyagi, trying to elimi-
nate the abnormal vessels would
have produced significant com-
plications, because the risk of
damaging brain tissue would
have been too high. Now, she

says, "it's a one-day process and it's much more precise,
only possible because we have a great team of subspecial-
ists, and the latest technology."

Christina got her Christmas wish. She was finished with

the procedures by mid-December, and since then she has
progressed even more, picking up where she had left off at
a dance studio. In June, she gave a stirring jazz dance recital.

The one lingering vestige of her stroke appears to be her

memory. Christina feels she needs to work harder to retain
what she learns at school. With cognitive therapy, howev-
er, that, too, is getting better. "I'm feeling great," Christina
says. "I think I've recovered really well."

That means everything to her physician. "It makes stay-

ing up at night, phone calls at 3 in the morning, all worth
it," says Dr. Tyagi. "It's the best reward you could ever ask
for."

COURTESY

OF
THE

BLUMSTEIN

FAMILY