Something to Dab About: Jack’s Second Chiari Surgery Goes Well

Apr. 15, 2019

Last year we brought you the story of Jack Cacace: middle-schooler, hockey player, milkshake aficionado. Jack and his family came to pediatric neurosurgeon Dr. Richard Anderson for treatment of Jack’s Chiari I malformation, a condition in which the shape of the skull “squeezes” the area where the base of the brain and the spinal cord join up.

Treatment means surgery, and there are two main options. One procedure is more invasive, and one less so. In the more invasive procedure, the surgeon opens the dura, the tough layer of protective tissue that fits around the brain and spinal cord like a sleeve. This step of the procedure carries the most risk to the patient by exposing the body to some risks that a closed dura prevents.

Opening the dura isn’t always necessary. Dr. Anderson, colleague Dr. Neil Feldstein and others know that very many cases of Chiari can be resolved while leaving the dura intact. This less-invasive procedure exposes the patient to substantially less risk. There is a potential downside, however: a small chance the Chiari will not be resolved and a surgery in which the dura is opened might be necessary. But the chance of avoiding potential complications of opening the dura is so great that, for many patients and families, opting for the less-invasive procedure makes the most sense.

So last year, Dr. Anderson, Jack and his parents agreed on the surgery that leaves the dura intact. The procedure went well, Jack healed afterward and he even got back out on the ice.

But Jack’s one-year follow-up brought some less-than-welcome news: “Jack’s MRI showed he was in the small percentage of patients who need a second surgery,” says his mom, Josephine. His Chiari wasn’t resolved, and he’d need the surgery that opened his dura.

While it wasn’t the news they had been hoping for, Jack and his “home team” (his mom and his dad) rallied. They’d gotten through the diagnosis and the first surgery as a team, and they’d do the same this time. Jack’s hockey team rallied around him, too. The day before Jack and his family left their home in Pennsylvania to come to Columbia University Irving Medical Center/NewYork-Presbyterian Hospital for the surgery, the team presented Jack with a photo of the whole team on the ice behind a big banner that read “We’re With You #22.”

This time, Jack and his parents knew from their previous experience a little more about what to expect at CUIMC/NYPH—those “game-day jitters” on the morning of surgery, for example, which would be calmed a bit by the warm and caring people they’d encounter. Josephine found that their expectations based on their previous experience were met once again: “We received the highest level of care from everyone who had contact with Jack,” she says. “We are very thankful to have found Dr. Anderson and New York Presbyterian.”

Jack’s second surgery went well, and he recovered in the Progressive Care Unit (PCU), a level down in intensity of care from the ICU, but a level up from the general Pediatric Unit. “The PCU is a wonderful addition to an already amazing institution,” says Josephine.

And Jack did well there. His parents were right there with him, and his supportive hockey team was there in photo form. Soon he was up on his feet, walking the halls and even dabbing (performing a brief, triumphant sports dance) at the nurses’ station. Dabbing isn’t usually part of the general postoperative recovery timeline, but it brought a smile to many faces in the PCU. Says Josephine, “It was a very emotional [several days], and we are thrilled with his progress.”

Now Jack’s back home, recovering and hoping to get back out on the ice again soon. When he does? Dabbing all around.

Read our original story about Jack Cacase here: For Chiari Surgery, Jack’s Family Traveled to Find Their “Home Team”

Read more about Dr. Anderson on his bio page here.

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