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Teen with 3-foot fishing spear in skull poses dilemma for doctors

June 19, 2012|By Laura J. Nelson

With the help of power tools and industrial-grade vise grips, Miami doctors have successfully removed a 3-foot spear that pierced a teenager’s skull during a fishing accident. And Tuesday, 16-year-old Yasser Lopez left the intensive care unit.

“It could be a complete recovery,” said Dr. Ross  Bullock, a neurosurgeon at the University of Miami-Jackson Memorial Hospital. “That is so rare.”

The afternoon of June 7, Lopez’s 15-year-old friend misfired a Cressi Sub SL spear gun while trying to load it, according to the Miami-Dade Police Department. The spear punched through the right side of Lopez’s forehead, 2 inches above his eye.

PHOTOS: Lopez' x-rays

Lopez’s friend called 911. As the EMTs wheeled Lopez’s gurney into the emergency room, a stainless steel rod protruding from his head, he was conscious and talking, but soon grew agitated and had to be sedated, Bullock said.

Doctors could feel the spear’s tip poking through the back of Lopez’s head.

“If you yield to the temptation of doing the King Arthur trick and just pull the thing out, you can cause a lot of damage,” Bullock said. “You have to take precautions.”

Instead, trauma doctors sawed off all but 6 inches of the spear, so Lopez would fit into the X-ray machine. The team found that the spear had cut a clean path, without rupturing any major blood vessels -- remarkable, Bullock said, given that the brain has more blood vessels than any other part of the body.

But how to remove the spear? If doctors pushed it through, Lopez would have 10 inches of stainless steel moving through his brain. If they pulled it back out, the spear’s tiny barbs – much like a miniature harpoon – would probably deploy.

Then, the family solved the problem: The end of the spear, they said, was detachable. So doctors borrowed a high-speed drill from Miami-Dade Fire Rescue.

By cutting round holes in the skull at the spear’s entry and exit points, doctors gave the weapon some wiggle room. Then, they clamped down on the tip using industrial-grade vise grips – preventing the barbs from deploying – and pulled gently in opposite directions. The shaft slid through Lopez’s forehead; the tip and barbs, through the back of his head.

Lopez survived what should have been a fatal accident for two reasons, doctors said. First, the spear missed all the brain’s vital structures. Additionally, puncturing the skull took so much energy that by the time the spear reached brain tissue, it was moving relatively slowly, resulting in less tearing and bleeding.

The brain continues to grow through the mid- to late-20s, Bullock said. The younger the patient, the higher the chance of re-growing damaged white matter -- the  tissue that helps different parts of the brain talk to each other.

“His CAT scan looked surprisingly normal,” Bullock said. “If someone had been 60 or 70 or 80, they would have done much worse – the brain is more brittle, the blood vessels tend to be more frail, they’re at more at risk of bleeding. With young people, neurogeneration is more vigorous.“

Rehabilitation will take two to three months, doctors said. Lopez can currently give short answers to questions such as, “Are you in pain?” He has very limited use of his left arm and left leg.

That’s because the right side of the brain controls motion on the left side of the body. Although each person’s cranial makeup differs, Bullock said, the right brain typically also controls creativity and spatial perception.


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