A neurosurgeon performs a delicate surgery so a child can ride her horse again
by Jessica Ennis
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| Ashley and her horse, Sampson. Photo by Kats Barry | When 10-year-old Ashley Hedgepath, a cheerleader, athlete and avid horse rider, started having headaches, her mother wasn't terribly concerned since headaches seemed to run on her side of the family.
"We just joked about it," Ashley's mother, Cathy Hedgepath said. "Headaches just go along with being a Copeland."
But the headaches became more severe over time. Then Ashley began vomiting and starting having flu-like symptoms. Ashley's parents took her to the doctor in neighboring Union City, Tenn. Her doctor thought Ashley was simply suffering from a sinus infection.
Several days passed, and Ashley didn't get any better. She also began to have double vision, but didn't tell her parents for a while.
"Ashley started looking 'funny' at us," Cathy said. "She was acting strange, and making goofy faces. We thought she was kidding around at first."
Her bizarre symptoms were a mystery to the family, and Ashley's doctor, John Clendenin, M.D., felt the family didn't need to wait any longer to figure out what was going on with their daughter. The family headed to their local Emergency Department. There, a CT scan found two spots on Ashley's brain which appeared to have hemorrhaged.
Ashley then made a three-hour trip by ambulance to the Monroe Carell Jr. Children's Hospital at Vanderbilt. After a four-day stay and several tests, the family learned that an MRI found eight cavernous malformations in Ashley's brain. One of the malformations that appeared to have bled was in her brain stem.
A cavernous malformation is a well-defined, often grossly visible blood vessel lesion that may reach a significant size.
Matthew Pearson, M.D., assistant professor of Pediatric Neurosurgery, wanted to watch Ashley for signs of the malformation becoming active again before he recommended surgery, as is standard procedure.
"Dr. Pearson said the area of the brain where the malformations were located is not an area you want to go to unless you have to," Cathy said.
These malformations rarely occur in the brain stem, which is the part of the brain that controls breathing, movement, digestion,
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| Ashley's surgery lasted eight hours. Photo by Anne Rayner | heart rate - most every function of the body. Pearson had only seen a few malformations in this particular area, and had never operated on one in the brain stem.
"Neurological specialists like myself usually just see the tip of the iceberg," he said. "If it's unusual to us, it's rare in the world."
The Hedgepath's local doctor recommended they get a second opinion, and so the family traveled to the Mayo Clinic.
"The doctor there looked at Dr. Pearson's tests which were about a month old and said what he was recommending was correct unless the malformation became active. We feel that it became active while we were at Mayo and progressed. Ashley started to have vertigo-like symptoms and her face began to draw like she had a stroke," Cathy said.
After the family returned to their hometown of South Fulton, Tenn., about three hours from Nashville, Ashley continued to get worse. She visited the local emergency room, and Jennifer Bryan, M.D., ordered a new MRI and was advised by Children's Hospital to bring the results to Pearson as soon as possible.
Pearson read the MRI and saw that her malformation had grown significantly in size. Pearson recommended surgery to remove the malformation in her brain stem for fear further bleeding could cause severe problems, even death.
"When we got back to Children's Hospital, we knew we were in the right place. We knew where we needed to be," Cathy said.
Pearson felt Ashley was a good candidate for surgery, and discussed Ashley's case with the other neurosurgeons during one of their weekly departmental meetings. Everyone in the department agreed surgery was Ashley's best chance to recover.
"If the malformation had been "quiet," we would have just continued to follow it, but it appeared to have been active enough that Ashley could not tolerate it any longer," Pearson said.
Ashley's parents asked her if she was willing to have the surgery and she agreed.
She said, 'I want what's best for me, I want to be regular Ashley again,'" Cathy said.
The surgery lasted a grueling eight hours - and was actually shorter than Pearson was expecting.
"It is much better to take care of this in a controlled environment, instead of an emergency environment. Everything came out smoothly," Pearson said. "We removed a golf ball-sized malformation from Ashley. It was certainly everyone in the OR that contributed to this successful surgery, it's not just me in there - it's a total team effort," Pearson said.
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Ashley and her family the day after surgery.
Photo by Anne Rayner | Ashley received a small incision behind the ear, which is easily hidden underneath her shoulder-length blonde hair - her head was not shaved. All of her stitches are made of absorbable plastic, so none will need to be removed. Even the bone removed during surgery was replaced with absorbable clamps, so no metal was left in her head. These small things are important to children, and Pearson tries to make any incisions resulting from his surgeries as invisible as possible.
"She has not complained throughout this whole ordeal," Cathy said. "She has been a real trouper. We are awe-inspired and amazed at how well she has been doing after surgery. It was the doctors and God working together to help Ashley. She is getting back to her old self again."
Most all of her symptoms immediately disappeared, except for the double vision, which will hopefully decrease with the help of an ophthalmologist. Ashley's biggest concern was how soon she will be able to ride her horse, Sampson. A few months after surgery, Ashley was relieved to know she could start riding Sampson again, and resume other physical activities she had been missing out on.
Pearson suggests that these cavernous malformations can be genetic. Ashley's mother, Cathy, had brain surgery at age 13 to remove what doctors then thought was arterio-venous malformation (AVM). Pearson believes Cathy likely suffered from the same condition as Ashley. Cathy and the Hedgepath's youngest daughter, Sara Catheryn, 5, both had MRIs and are currently awaiting the results.
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