Minimally invasive procedure helps patient recover quickly from brain surgery without any side effects

Drew and Laura Mendrygal

In 2017, Drew Mendrygal gave his wife, Laura, a “heart attack” when he had his first seizure. They were living in Oregon at the time. “When they brought me in, they did an EEG [electroencephalogram] and took a couple of scans of my head.” Drew said. “There was an abnormality along the midline about two-centimeters square that they believed caused the seizure.”

After additional evaluation, it was discovered that Drew had been having multiple seizures, he just wasn’t aware of them. “They put me on antiseizure medication, which worked for some time,” he said. Unfortunately, it meant that Drew’s life was somewhat constricted. For someone who used his workouts as a coping mechanism for whatever life threw at him, he suddenly discovered that he couldn’t go swimming by himself.

Second significant seizure
Clark C. Chen, MD, PhDDrew and Laura then moved to Minnesota and in late December 2019, while still taking the medication, he had another significant seizure. That led the couple to meet with Neurosurgery Department Head Clark C. Chen (pictured at left), MD, PhD. “I was told by my doctor in Oregon that Dr. Chen was the guy I should see,” said Drew. “During our meeting, Dr. Chen mentioned a minimally invasive surgical option that hadn’t been discussed in Oregon. After checking all the boxes with my other medical providers, it seemed to be a good time to have the surgery.”

During his meeting with Drew and Laura, Dr. Chen learned about the side effects that the antiseizure medication was having on Drew. “Anti-seizure medications suppress the electrical activity of the entire brain, not just the area responsible for the seizures,” he explained. “It means that many patients don’t feel ‘100 percent’ while taking these medications.”

Guided by knowledge
In addition, Dr. Chen wanted to better understand the growth that was causing Drew’s seizures. “He said we can’t be guided without knowledge,” said Laura. Drew agreed, adding, “They couldn’t say it was a tumor or something else without a sample. Otherwise, it’s just speculation.”

Drew’s scans showed that the abnormality was located on the left side of the brain, known as the left mesial temporal lobe. This area is important for cognition and memory. After conferring with a multidisciplinary care team, consisting of experts from epileptology, radiology, and oncology, Dr. Chen developed a personalized surgical plan for Drew.

There were two goals for the procedure:

  1. Use a real-time MRI-guided biopsy process to obtain samples from the region of abnormality
  2. If the sample proved to be cancerous, use a minimally invasive laser procedure to destroy the abnormal tissue, thus enabling Drew to be slowly weaned off the antiseizure medication.

The surgery was scheduled for January 6, 2021 – a historical day for the country. “I missed everything that happened at the Capital,” Drew said. “It gave my wife something to distract her while I was in surgery, though.” Laura kept thinking, “How do I explain this to him?”

Intraoperative MRI
The procedure was performed in a state-of-the-art surgical suite equipped with intra-operative MRI. Using the real-time MRI, Dr. Chen identified the safest path to the abnormality and then made a three-millimeter incision in Drew’s scalp, which is smaller than the thickness of two pennies. “The incision of this surgery is so small that many patients have a hard time finding it a week after surgery,” said Dr. Chen.

Through this tiny incision, a small hole was made in Drew’s skull from which samples of the abnormality were obtained. The tissue was immediately examined by a neuropathologist, who found cancerous cells. Armed with this information, Dr. Chen inserted a laser probe into the region and destroyed the cancer.

The final pathology report suggests that the cancer was a ganglioglioma, a rare low-grade tumor. “Surgical removal or laser treatment of this type of tumor essentially results in a cure.” said Dr. Chen.

Drew’s recovery from the surgery was speedy. Amazingly speedy. The day Drew came home, he was standing up playing video games in their living room, according to Laura. “There really wasn’t a time when you could tell he was recovering from surgery,” she said. Drew did struggle with hiccups for a few days. “I had brain surgery and ended up with a slight annoyance,” he said, laughing.

Reaping the benefits
Before the development of the minimally invasive laser treatment, a tumor located in the same area as Drew’s could only be removed or biopsied through a craniotomy, a procedure requiring removal of a sizable portion of the skull, according to Dr. Chen. “This type of surgery is associated with the risk of vision and/or cognitive decline as well as prolonged recovery,” he said. “With laser-aided, minimally invasive procedures, we have bypassed that completely. Patients like Drew reap all the benefits without the side effects associated with traditional brain surgery.”

When Drew thinks about all he went through, he admits, “It was scary. I had moments when I thought, is this the end of me? But I don’t feel I’ve really changed at all other than having a heightened appreciation for the time I have left. I’m ecstatic about what Dr. Chen and my care team did for me.”

Drew now looks forward to a new phase in his life when he no longer needs to worry about seizures. And when he can have that first swim by himself.

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