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Issue Date: March 2007

Top Docs Brain Surgery

Sixteen-year-old Lance Rice’s case was so rare that doctors couldn’t find another one like it. Suffering from both severe epilepsy — among the 20 percent of patients who don’t respond to medication — and hemophilia, Rice needed a peach-size portion of his brain removed to stop his seizures.
But without the clotting proteins in his blood, “any procedure that can cause bleeding in a normal patient can be catastrophic,” says Dr. William E. Bingaman, interim vice chairman of Cleveland Clinic’s Neurological Institute and head of epilepsy surgery.
In a first for Cleveland Clinic and possibly the world, Bingaman opened Rice’s skull and implanted two electrodes directly on his brain. After replacing the skull, other electrodes were attached to his head and skin. Bleeding was controlled with daily injections of a blood protein that helps transport vitamins and fight infection, which Rice was lacking.

They waited a week until Rice had another epileptic attack. By monitoring the seizure activity, Bingaman could determine if the episode was localized in one area of the brain, which could be removed in a second operation. The surgery is only performed when removing the damaged area won’t cause other problems.
In Rice’s case, the damage was primarily in his left frontal lobe — the area that normally controls speech and memory — but other parts of his brain had taken over the controls for these functions. That allowed Bingaman to perform a second surgery to remove one-fifth of the left side of Rice’s brain.

Since the November surgery, Rice has not reported any seizures.

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