"Thank You for Fixing my Head," Young Patient Tells Dr. Origitano
MAYWOOD, Ill. -- One minute 8-year-old Abigail Avitia was running around and playing with her sister, and the next moment she was throwing up and complaining of a terrible headache. Abigail was experiencing a hemorrhage deep in her brain and was taken to Loyola University Hospital. In a delicate 13-hour surgery, a team led by Dr. Thomas Origitano, a neurosurgeon, removed the source of the problem -- a life-threatening tangle of blood vessels called an arteriovenous malformation (AVM). Abigail has made a fast recovery and has returned to her third-grade classroom at Westchester Intermediate School. "She's back to her normal self," said her mother, Jessica Avitia. "You would never know she was in the hospital for a month and had brain surgery." Origitano, chairman of the Department of Neurological Surgery at Loyola University Chicago Stritch School of Medicine, has performed hundreds of brain surgeries in his career. A successful case such as Abigail's, he said, "helps me appreciate what a privilege it is to be in my profession." Origitano treasures a card Abigail drew for him after her surgery. "Thank you for fixing my head," she wrote. "And I mean it." About 300,000 Americans have AVMs, according to the National Institute of Neurological Disorders and Stroke. AVMs form before birth or shortly thereafter. Arteries, which are designed for high blood pressure, connect to low-pressure veins. This can cause bleeding. Each year up to 4 percent of all AVMs hemorrhage. Abigail did not suffer lasting damage from her hemorrhage, but she was at risk for future hemorrhages that could have caused death or permanent disability. Abigail came to Loyola on Dec. 21. As she recovered in the pediatric intensive care unit from her hemorrhage, she was monitored minute-by-minute throughout the holidays. Before surgery, Dr. John Whapham, a neuroendovascular surgeon, performed a type of X-ray called an angiogram. Whapham inserted a catheter in Abigail's leg and guided it through blood vessels up to the AVM. The catheter released fluid in the blood vessels that showed up on the X-ray. The angiogram revealed that Abigail's AVM was extremely fragile and prone to bleeding. Origitano's team brainstormed about the best approach to treat Abigail's AVM. A less-invasive technique using a catheter would be too risky because merely passing a catheter into the fragile blood vessels could cause bleeding, Whapham said.
The team decided that surgery would be the best approach. Brain surgery is never simple, but Abigail's procedure was especially challenging. It's the type of case, Origitano said, that keeps him up at nights. Abigail's AVM was about the size of an adult thumb. After careful planning, Origitano and a second neurosurgeon, Dr. Hazem Ahmed, performed the surgery Jan. 10. Origitano and Ahmed carefully disconnected hundreds of blood vessels, one at a time. Abigail came through the surgery well. She recovered in the pediatric intensive care unit and went home Jan. 15. "This was a multidisciplinary effort involving many physicians, nurses and technicians," Origitano said. "It took a lot of talent, technology and teamwork -- and the right hospital."