Brain Surgery Eliminates Cause of Seizures

Genay and Steven Steinhilber
Genay and Steven Steinhilber

Steven Steinhilber, 23, opened a can of soda and as the first notes of carbonation fizzed into the air, he turned to his wife, Genay, and said, "I don't feel well," right before passing out.

Steinhilber was rushed to a local hospital where doctors diagnosed him with dehydration. Four months later, while out at a bar with some friends, Steinhilber passed out again, prompting another emergency room trip.

"If I was going to have brain surgery, I wanted to have it here,"

This time, doctors found a small mass in Steinhilber's brain. Knowing that the mass needed to be removed, Genay researched online and called on the University of Chicago Medicine's Jacqueline Bernard, MD, assistant professor of neurology. Bernard suspected Steinhilber was having seizures. She referred him to Issam Awad, MD, professor of surgery and director of neurovascular surgery at the University of Chicago.

Doctors Issam Awad and Jacqueline Bernard

Issam Awad, MD, professor of surgery and director of neurovascular surgery, and Jacqueline Bernard, MD, assistant professor of neurology, led Steinhilber's care team.

Awad specializes in cerebrovascular anomalies, and has published extensively on the various lesion types and their consequences. He co-edited the first book on cerebral cavernous malformations (CCM), clusters of brittle blood vessels that can be found throughout the brain. Awad frequently evaluates patients throughout the world with these anomalies using highly specialized MRI equipment at our hospitals to detect CCMs many times smaller than would a normal scan, and carefully evaluates the genetic causes involved in a number of cases.

Steinhilber had a single, kidney bean-size CCM deep in his brain that was oozing blood and causing seizures. Repeated scans showed the mass had grown, so Awad recommended Steinhilber have surgery to remove it to prevent more bleeding. Steinhilber agreed.

"If I was going to have brain surgery, I wanted to have it here," he said.

The operation was performed with special computer-guided imaging with minimal disturbance of the brain. Steinhilber's surgery was a success, and his symptoms have stopped. Since the surgery, Bernard has cleared him to resume working and driving.

In conjunction with his surgery, Steinhilber donated his CCM lesion tissue to be studied by Awad. Through collaboration with colleagues at the University of Chicago, Duke University and UC San Diego, Awad's team is studying lesions from humans and mice, and has detected a signaling pathway that, when blocked, may reduce or prevent CCM formation.

"Our goal, ultimately, is to shrink these lesions and treat them with medications, so fewer patients will need brain surgery in the future," Awad said.

July 2011