A Frightening Ordeal
Emergency brain surgery saves teen from severe sinus infection
By B.J. Walk
It was 4 o’clock in the morning when Felipe Martinez went outside the Sam S. and Rose Stein Emergency Care Center at Rady Children’s Hospital-San Diego and looked heavenward. “I thanked God for letting me have my son for 16 years,” he recalled of that unforgettable night in July 2011. “Then I called my wife and told her to come to the hospital, and I called my relatives and asked them to pray.”
Felipe and his wife, Maria, were facing the most frightening ordeal of their lives. Their only son, Philip Anthony, was about to be wheeled in for emergency brain surgery. Surgeons would work to clear a severe infection lurking in the thin lining between the skull and the brain. “I told my son, ‘You’ve got to be brave,’” said Felipe. “He is an amazing, strong kid. He told me, ‘I’m ready and I am not afraid.”’ It was a somber moment, made all the more inconceivable by its seemingly innocuous start with a sinus infection.
“When people think of sinusitis, they think of something being a little more severe than a cold,” said Anthony Magit, M.D., an ear, nose and throat specialist at Rady Children’s and the hospital’s immediate past chief of staff. “But sinus infections can, in rare instances, spread into the brain and cause very significant intracranial infection.”
Such was the case for Philip, who had come down with a cold a few weeks earlier and was treated with antibiotics. But he didn’t get better and had fever, severe headaches and fatigue.
One day, he woke up with a large bump on his forehead. “It looked like a big knot, but he hadn’t hit his head,” said Felipe, who took him to Rady Children’s Emergency Care Center. “Doctors in the ER recognized right away from the swelling of his forehead that this was no ordinary sinus infection,” said Dr. Magit, also a professor of surgery in pediatric otolaryngology at the University of California, San Diego. The brain scan revealed just how bad it was — the raging infection had moved through Philip’s head and now involved the covering of his brain.
John Bradley, M.D., chief of Rady Children’s Infectious Diseases Division and co-chief of UC San Diego’s Pediatric Infectious Diseases Division, said the pressure from the severe sinus infection in Philip’s forehead had pushed the infection both forward — under the skin on his forehead — and backwards, through the skull. “The abscess was pushing on his brain, so relieving this pressure was critical,” he said.
Dr. Magit and Hal Meltzer, M.D., a pediatric neurosurgeon and UC San Diego Health Sciences professor of neurosurgery, performed different aspects of the delicate operation needed to relieve the infection’s mounting pressure. After making an incision hidden in the hairline, they were able to gently pull down the skin to get to the infected area.
“We cut out a small piece of skull bone so we could drain the infected area that had been pressing on the brain. Then we put the bone back and inserted a tiny titanium plate and screws to hold the bone together,” Dr. Meltzer said.
Dr. Magit used endoscopic instruments for his part of the operation, focused on the sinus cavity. “We used a telescope to visualize the opening of the sinuses, removed a piece of bone, drained the infection, then followed up with irrigations to wash out the nose and sinuses,” he said.
Following the surgery, Dr. Bradley analyzed fluid collected from the infected areas. “We identified the bacteria and were able to ensure that Philip received the best antibiotic possible to clear the infection,” he said.
Philip spent 15 days in the hospital. His parents, two sisters and a boatload of friends from their tight-knit church and community visited often. A month-long recovery followed at home, and Philip was back to health just in time for the new school year. “Dr. Meltzer took my stitches out a week before school started,” he said cheerfully.
A year has passed since the surgery, and Philip, who has made a full recovery, is now a junior at High-Tech High. A bright student, he enjoys math, science, computers, video games and his greatest passion — music. Philip has a D.J setup and provides music at various community events and parties. He eventually wants to become a sound engineer. “I kind of appreciate things a little bit more now,” he said.
His mom, Maria, says the family is very blessed, and she is grateful for the care her son received at Rady Children’s.
U-T San Diego, October 2012