After several operations and multiple hospitalizations, doctors in both the U.S. and Mexico could not remove a life-threatening lesion in the brain of nine-year-old Farid Antonio Bitar Bonotto. Using a new type of liquid called Onyx for the first time, doctors at Barrow were able to embolize the lesion and ultimately accomplish what others could not. To support the amazing work of the physicians at Barrow click here.
In September, Barrow neurosurgeons removed an enormous tangle of blood vessels from the brain of a nine-year-old child—and in so doing, gave the boy a new start in life.
Farid Antonio Bitar Bonotto came to Barrow Neurological Institute three years after he was diagnosed with a cerebral cavernous malformation (CCM) in Guadalajara, Mexico. A CCM is a cluster of fragile blood vessels in the brain that is prone to leaking blood. When it hemorrhages, a CCM can cause seizures, strokes, and, in some cases, death. The abnormality occurs in about one of every 250 people.
“What’s unique about this case was the size of the CCM and the numerous unsuccessful attempts to eliminate it,” says Robert Spetzler, MD, director of Barrow.
Farid first saw a pediatrician in 2005 because of shortness of breath. The doctor noticed differences between the right and left sides of the child’s face and ordered a CT scan. That’s when the enormous CCM—perhaps the largest of its type ever recorded—was discovered.
And thus began a long journey for Farid, a journey that included multiple doctor’s appointments, hospitalizations, and operations in both Mexico and the U.S. In the first surgery to remove the lesion, a neurosurgical team in Guadalajara stopped the operation after 16 hours and massive blood loss. Before reaching Barrow, Farid also underwent a shunt placement to relieve hydrocephalus and several embolizations to prevent bleeding in the weak vessels of the CCM. But none of the surgeons in Mexico or the U.S. was able to remove the lesion.
In February 2008, Farid experienced several severe breathing attacks and was air-evaced to Houston. Although physicians could not pinpoint the problem, Farid’s family was concerned that the CCM could be involved. Farid’s uncle, an orthopedic surgeon, felt strongly that the CCM should be removed. He asked Farid’s doctor in Texas who he would recommend. He responded, “Dr. Robert Spetzler.” Farid’s uncle soon made arrangements for a trip to Phoenix.
Nervous about what lay ahead for her son, Anna went to the hospital chapel to pray. “Do we embolize? Do we do surgery? Go home?” she asked. As she was praying, Anna closed her eyes and saw a rainbow of vivid colors and knew what she must do.
The Barrow team used a two-step approach to remove the CCM. First, endovascular neurosurgeon Felipe Albuquerque, MD, assisted by Shervin Dashti, MD, PhD, a neurovascular fellow at Barrow, used a new type of liquid called Onyx to embolize the CCM. The liquid was delivered into the vessels of the CCM via a catheter. Once inside the vessels, the Onyx solidified, sealing off blood flow into the abnormal vessels and reducing the risk of bleeding. It was the first time Onyx has been used to embolize a CCM.
The following day, a team led by Dr. Spetzler performed surgery to remove the CCM. “We were able to successfully remove it because we had published about this type of lesion and were prepared to deal with it,” says Dr. Spetzler.
At Farid’s final appointment before returning to Mexico, his doctors were excited to see how well the child was doing.
“To see a little boy who had what was a life-threatening lesion and who’s now perfect neurologically—it doesn’t get anymore gratifying than that,” says Dr. Albuquerque.
