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Isaiah

At age 5, Isaiah Garcia has already had quite a journey.
At 6 months his pediatrician noticed Isaiah’s head seemed larger than normal. He soon began getting ill frequently, suffering high fevers, vomiting and having seizures. It was unclear what was causing Isaiah’s symptoms and his parents, Julie and Erin Garcia, turned to Children’s Hospital for help.

IsaiahIsaiah was referred to Children’s pediatric neurosurgery department. Dr. Meredith Woodward, a neurosurgeon, gave the Garcias an answer. She diagnosed their son with hydrocephalus, a potentially life-threatening condition caused by excessive accumulation of fluid in the brain.

“Dr. Woodward was the turning point,” said Julie. “All the clues were there, but she made the first diagnosis.”

Although hydrocephalus is sometimes referred to as “water on the brain,” the “water” is actually cerebrospinal fluid (CSF) – a clear fluid surrounding the brain and spinal cord. Often due to an obstruction preventing proper fluid drainage, the excess fluid can push fragile tissue against the skull, causing brain damage or even death.

Affecting about one in every 500 children, hydrocephalus can be congenital, like Isaiah’s, or acquired. Treatment usually involves surgically inserting a shunt system to relieve the pressure. The system diverts the CSF flow from the central nervous system to another area where it can be absorbed as part of the normal circulatory process. Shunt systems generally require regular medical follow-up and, when malfunctions occur, some type of revision.

Dr. Woodward performed Isaiah’s first ventricular shunt surgery when he was about 1 year old. Since then, he has required a second shunt in his head and numerous shunt revisions. Isaiah’s case was especially complicated. Dr. Woodward began managing his condition with Children’s other neurosurgeon, Dr. Gary Magram, to provide the youngster the best possible care.

“Isaiah has a different pathology and unusual hydrocephalus,” said Dr. Magram. “He doesn’t respond to conventional treatments. Each child is unique. If something doesn’t work, we try something else.”

In April, the neurosurgeons escalated Isaiah’s treatment and took a new approach. They turned off the shunts in Isaiah’s head and placed a new shunt system in the lumbar space of his spine, thereby redirecting the CSF to the peritoneal cavity. Although the procedure is used more commonly in adults because a child’s growth may create added complications, Drs. Magram and Woodward concluded the benefits outweighed the risks in this situation.

An expert in his field with previous patents on shunt designs, Dr. Magram has started new research and development to improve the devices. His goal is to reduce shunt malfunctions and make them drain more effectively “to provide a higher quality of life” for patients like Isaiah. “What amazes us about Isaiah and his family is their ability to cope with and handle going through such a difficult problem,” said Dr. Magram.

With the new system, Isaiah has gone the longest so far without recurring symptoms. “From the day Dr. Woodward and Dr. Magram took Isaiah’s case, he hasn’t been as sick,” said Julie. “He has only improved.”
Isaiah’s case is an example, said the neurosurgeons, of how Children’s can manage and offer varying treatment options for ongoing complex problems. Shunt procedures can be risky, potentially damaging the brain. Children’s expertise combined with the latest technology - including computer-guided procedures and smaller, more precise endoscopes - make a significant difference.

“After all the surgeries, Isaiah has no developmental delays,” said Erin, adding that Isaiah starts kindergarten this fall. “He’s still the kid we love and know.”

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