A leading-edge brain surgery debuts at Eskenazi Health

In August of 2015, Colton Linkous was one day away from moving into his dorm at Cedarville College in Ohio as a full scholarship player on the school’s basketball team. Unfortunately, Colton started experiencing seizures that day which led to an MRI where a lesion in the left temporal lobe of his brain was discovered that represented a presumed low grade glial tumor. The tumor was in close approximation to the motor and receptive language centers of his brain, and Colton was transferred to Indianapolis for neurosurgical review with Dr. Jesse Savage, a neurosurgeon with Eskenazi Health. 

The following is a Q&A with Dr. Savage where he speaks about his treatment of Colton Linkous that resulted in the successful execution of an awake craniotomy.

Q: How did you first treat Colton when he came to you?
A: We initially treated his seizures with anti-epileptics and repeat brain imaging and he continued to have uncontrolled seizures. There were radiographic findings associated with this tumor where we felt surgery was in his best interest.

Q: You suggested to Colton that he undergo an awake craniotomy. How would you describe that procedure?
A: An awake craniotomy with brain mapping is a technique that allows a neurosurgeon to stimulate the surface of the brain while the patient works through a battery of language testing in order to potentially identify precise areas of functional relevance so that a trajectory of tumor resection can be made without disrupting the patient’s ability to speak and comprehend.

This is an exciting/intense operation for both the patient and the surgical team as a window of the skull is removed to expose the surface of the brain for mapping while the patient is awake and interactive. We felt that Colton was a great candidate for an awake craniotomy as his tumor was in close approximation with the language centers of his brain.

Q: Was it difficult to talk Colton into undergoing that procedure?
A: No, not at all. Colton and his family are very reasonable people and very steadfast. He’s not what I would describe as an emotional kid. He’s a very good basketball player and has that mentality of a competitor. He was very at ease at the beginning as we managed things conservatively, and he was happy to be doing the best thing long term.

Q: Was Colton awake as the surgery began?
A: He was asleep at the beginning of the operation where we do our exposure and create a window to the brain. After that we lighten the anesthesia and at that point he’s awake and our team uses a series of cards and pictures where we have him name objects and do mathematics and a series of verbal exercises to demonstrate an area less important to language where we might make our initial incision. We open up the brain and use a stimulator that can stimulate the surface of the brain by going through a battery of language tests.

Q: What are some of the points of concern for the neurosurgeon and patient with an awake craniotomy?
A: Concerns range from discomfort associated with the procedure. It’s a very anxiety-provoking operation. You have people who have the strongest fortitude in the sense that you are awake in the operating room with your head fixed in pins with your brain exposed going through a battery of tests. There are concerns in regards to stimulating the surface of the brain where you can invoke a seizure that can be difficult to control and can cause swelling of the brain. Also, because the patient is awake and breathing on their own, we don’t have the same airway protection that we do in a standard intubated case, so a patient who has a seizure and has an unsecured airway can cause a problem in terms of requiring intraoperative intubation, which is not as controlled as a standard intubation in a standard general anesthetic surgery. Then we worry about all the same problems you can have with any complex intracranial surgery in terms of bleeding or stroke.

Q: How would you describe Colton’s demeanor during the surgery? Did he ever get nervous or anxious?
A: The kid was totally fearless.

Q: While the surgery was a huge success, how did Colton’s recovery evolve in the early stages?
A: He was in the hospital, I believe, for three days. The first night he was in the ICU so we could keep a close eye on him. The second day he had an MRI to demonstrate that there was no problem in the operative field and that we had removed the entire tumor. At that point, he was discharged for home where he continued with outpatient intensive speech therapy over the next four to six weeks. Since then, and now I believe we’re about six months out, he’s been released from the speech therapy.

Q: What’s the latest news about his recovery?
A: He’s doing great. He’s very happy that his tumor is completely removed. He had a gangliocytoma, which is considered a World Health Organization Grade One tumor, meaning that it’s a benign lesion that can be cured with surgery alone. He’s practicing at a local gym and has gone to some workouts with his basketball team, and he’ll be back to Cedarville sometime in the next month or two.

Q: Is this a common surgical procedure at Eskenazi Health and across the nation?
A: This was the first surgery of its kind at Eskenazi Health and makes Eskenazi Health one of the few hospitals in Indiana -- as well as in the country -- where this operation is performed.

Q: What is it like for you and your team to know that you can dramatically improve the lives of someone with this type of innovative and ground-breaking procedure?
A: It’s very fulfilling. I try to do the best for every patient. Sometimes patients have great outcomes and other times patients have outcomes that are less desirable. In Colton’s case, we have a young guy who’s successful with his whole life in front of him and finds out on the day before he moves in at college that he has a brain tumor. We were able to successfully remove his tumor and offer him the opportunity of a surgical cure, as well as control his epilepsy, so that he’s able to return to doing the things he loves in life – go to school, play basketball. So in that sense, it’s very rewarding.

About Dr. Jesse Savage
A Warsaw, Ind., native who graduated from Purdue University with BA, MS and PhD degrees in biology, Dr. Savage graduated with honors from the Indiana University School of Medicine in 2009, prior to finishing his residency in neurological surgery at the University of Virginia in Charlottesville. He completed his neurosurgical fellowship in Auckland, New Zealand in 2014, and later served as the chief neurosurgical resident at the University of Virginia Department of Neurological Surgery.  Dr. Savage joined Goodman Campbell Brain and Spine in Indianapolis as a neurosurgeon in July 2015, and is currently seeing patients at Eskenazi Health.

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