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Issue Date: March 2012


Best Doctors 2012: Head On

Patients with epileptic seizures seek out the Cleveland Clinic's Dr. William Bingaman, who does almost 200 surgeries a year.
Jeff Niesel

Twenty-two-year-old Yazeed Al-Zouman is lying unconscious under a canopy of bright blue blankets and fluorescent lights. A team of assistants and doctors, including a surgeon who flew in from Australia to observe the procedure, huddle around Yazeed's skull, where there's a large opening about 6 inches by 4 inches wide.

A variety of plastic vacuum tubes, stained red with blood, pump and suck fluids in and out of giant percolating machines. Dr. William Bingaman, vice chairman of the Neurological Institute and head of the section of epilepsy surgery at the Cleveland Clinic, occasionally checks a monitor that shows images of the brain as he uses a scalpel to remove tissue from the man's brain. He then uses a bipolar device to coagulate the tiny blood vessels and stop the bleeding.

Bingaman, who has just spent three hours extracting the tumor that was causing the Saudi Arabian man to have seizures for the past three years, appears calm and at ease, despite the fact that the surgery is risky and could result in partial paralysis. On a CT scan, he points to the man's frontal lobe and identifies the part of the brain that he just removed. "We cut this large area out," he says pointing to the computer screen, where an abnormal splotch of white is visible against the brain's dark region. "It won't ever grow back, but it will fill in with spinal fluid, and we'll do an MRI every three months for a year."

This isn't the first time Yazeed has undergone a right frontal lobectomy for his seizures. Saudi doctors also found a tumor, operated and removed it. The seizures, however, didn't stop. So Yazeed and his family came to Bingaman, a world-renowned expert who performs close to 200 epilepsy surgeries a year, a remarkable feat when you consider that most hospitals only perform about 20 such surgeries each year.

Bingaman, 47, realized he wanted to be a physician when he was a junior in high school in central Pennsylvania. He applied for early decision at Johns Hopkins University, where he studied chemistry as an undergrad.

"No one in my family is a physician," he says. "My dad was a chemist, and my mom worked for the Pennsylvania Department of Education." Bingaman then went to Temple Medical School in Philadelphia. His second year of medical school, he met another student who was interested in neuroscience and led a neuro-anatomy discussion group that Bingaman joined. After his friend accepted a residency at the Cleveland Clinic, Bingaman followed in 1990. Upon completion of his residency, he set out to be a minimally invasive spine surgeon but couldn't find an opening other than as a clinical associate.

"Clinical associate means we'll pay you more than a resident and give you a year and see how it goes. It wasn't a ringing endorsement by any means," says Bingaman, who lives in Kirtland with his wife and three kids. "I started seeing patients and was seeing mostly spine patients."

It was at this time that neurosurgeon Youssef Comair, an expert in the epilepsy field, told Bingaman he was taking a job at the American University of Beirut. Comair and neurologist Hans Lüeders, a duo Bingaman says is one of the top two epilepsy teams in the country, called Bingaman into a room and told him he should be doing epilepsy surgery. "It was an honor, but it was completely off my radar," he says.

Bingaman spent the next several months learning epilepsy surgery with Comair. One of his first patients was a 1-year-old girl who needed to have half her brain removed because she was having hundreds of seizures a day. Comair originally told Bingaman they would do the surgery together, but he left for Beirut two weeks before the hemispherectomy was scheduled.

"I was terrified of this case," explains Bingaman. "We did some surgery and then needed more surgery [because the brain malformation was so extensive]. We eventually got her seizure-free, and it was an awesome feeling."

Many of his patients have tried a gamut of medications and still have seizures, often leaving people discouraged.

"When they come to see me, it's because everything has failed," he says. "These patients are not dying of awful brain tumors or aneurysm rupture. They're younger, for the most part, and we're able to fix 70 or 80 percent of them. They go back to their life and they're happy."

The success stories have multiplied over the years. In his office, Bingaman has a couple shelves set aside for the mementoes he gets from patients. He has a signed photo from Trenton, a young hockey player who had seizures that prevented him from playing the sport. Although the boy wasn't able to return to hockey because he lost his peripheral vision, he now leads a normal, seizure-free life.

Bingaman also points to a ceremonial native statue from an African patient and a boomerang from an Australian he treated.

"When they see me, they're often unwilling to let their hope shine through," he says. "Five years later when they're still seizure free, they finally believe."

Comments:
Thursday, April 05, 2012 9:43:55 PM by Maria Shine Stewart
Great writing by Jeff Niesel. I've known people with intractable seizures in an era before treatments like this were around. It's amazing what innovation and skill can do.

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