Surgical Fixes for Kids' Brains
by Maryann Brinley

A grandmother driving a sports utility vehicle accidentally runs over her young grandson’s head with the car. Not once but twice. “It was almost unbelievable. He was just about dead. She was on
suicide watch.”

While traveling in her mother’s car, a 6 year old unsnaps her seat belt to check on her baby brother. In that instant, the car, going about 30 miles an hour, is involved in a collision and when the airbag deploys, this little girl is “jettisoned big time. There was a question about whether or not to operate on her head. We did and I thought she was going to die on the table in the OR.”

A 14-year-old catcher on a baseball team leads his team to the quarter-finals in state competition, earns the reputation of hero, and later sustains severe head injuries in a skate-boarding accident. “The injury he sustained was very, very serious. We were in a scenario where this child was going to die and so desperate that the hospital let me try what was a new technique I had learned as chief resident at Loma Linda University Medical Center.” A graduate of the University of Illinois Medical School, Catrambone was completing his fellowship at James Whitcomb Riley Hospital for Children in Indianapolis at the time.

Head injuries are rated in categories from mild to moderate to severe, on what is known as the Glasgow Coma Scale (gcs). Mild falls between 13 and 15. “This
little girl was admitted to UMDNJ-University Hospital with a gcs 4 rating or very severe. It was a case of child abuse. She had a subdural hematoma and the intracranial pressure was so severe that we took her to the OR immediately. While we were rolling her into the operating room, her pupils dilated so much that her prognosis looked really bad. Brain swelling was so significant that I wasn’t sure if we would be able to close the skull.”

Stories with happy endings — like all four of these unforgettable Catrambone memories — have astonished him from the very beginning of his medical training. “I really enjoy caring for these patients. Through our management, they live. Yet when they are first admitted to the hospital, there is a question about whether they will live or die. Watching their progress from being comatose or very, very sick, getting them through that period and having them wake up to meet me, well…it is just pretty amazing.” Catrambone can lean back in his chair on the eighth floor of the Doctors Office Center at the Neurological Institute of New Jersey (NINJ) on the Newark campus and quickly fill a TV producer’s idea book for prime time drama. He lives it and he loves it.

“There were several things that influenced my choosing pediatric neurosurgery,” he explains. At a point in his career when he needed to decide between academic medicine and a private practice, he became a father. “So my own children were a
factor.” His daughter Samantha is 7; Jeffrey is 4; and Jackson recently turned 1. Married to his medical school classmate, Catrambone laughs about meeting his wife, Renee, in the cadaver laboratory. She is now a practicing pediatrician who juggles motherhood with ER work at two New Jersey hospitals.

Besides his own children, what also motivated this neurosurgeon were his pediatric patients. Years later, you can still see how the memory and the recovery of that little boy, whose grandmother nearly killed him with her SUV, stir him. Above the child’s hospital bed was a photo his family had hung. “In the picture, this little boy had so much personality but when I was first taking care of him, he was comatose. We had done a craniectomy and put him into a medically induced coma. Slowly but surely, though, I watched him wake up, become alert and eventually recover his personality.”

Certainly an optimist, Catrambone has been known to be outspoken in the UH trauma unit. “I’ve handled different types of cases there and I find myself saying, ‘I think he or she is going to be fine,’ about a patient when others think the opposite.” In fact, in his clinical and surgical work as well as in his research on pediatric hydrocephalus, pediatric brain tumors, advanced minimally invasive neuroendoscopy and management of pediatric head injury, this willingness to be innovative and positive comes through often.

What also makes him happy at the moment is a grant from the New Jersey Commission on Science and Technology allowing him to explore how a child’s optic nerve might offer a window into cranial pressure “We have a theory that by looking through the retinal anatomy and measuring the optic nerve head, we will be able to figure out if a shunt has become a problem because of raised intracranial pressure.”

A shunt is a flexible silicone rubber tube that is inserted into the body to treat
hydrocephalus (excess spinal fluid surrounding the brain). Complications can develop and shunts require regular medical monitoring so being able to diagnose by simply looking into a child’s eyes could make life easier for the one in every 500 children who develop hydrocephalus. The NJMS Division of Pediatric Neurosurgery is currently the only source in the state for the placement of a programmable device for checking shunt valve pressure but Catrambone’s plan makes use of a Heidelberg Retinal Tomogram II to measure optic nerves and cranial
pressure.

As one of seven children, Catrambone’s parents always made it clear when he was growing up that their children were their first priorities. “I think our family is still unusually close.” An accountant, his father advanced to become vice chancellor at the University of Illinois, where he is credited with helping to build the institution from a two year community college to a major research university. His mother, a medical laboratory technician, always talked about medicine and becoming a doctor. “I think she regretted not doing it herself and this influenced me somewhat. I’m third in line,” he says and then jokes, “I’ve never met anyone who can eat as fast as I do. You had to in my family. If you didn’t, the food would be gone.”

Working under Peter Carmel, MD, Director of the Center for Pediatric Neurosurgery at NJMS, since the fall of 2002 has been stimulating for Catrambone. Not only was Carmel a reason for moving here to New Jersey, but the age of the University was also a factor in this career decision. “Universities are like civilizations,” he says. “Catching them at the start of their development will influence what you as an individual are doing in large part. Plenty of other universities are big, bureaucratic, set and comfortable about where they are. UMDNJ is at a point where it is still in a building phase.”

When he was an intern at the University of Illinois Medical School in the 1990s, the local Chicago newspapers ran a series called “ The Killing of Our Children.” “Every time a child was murdered, it made the front page.” Catrambone believes that UMDNJ surgeons and physicians like himself are so “passionate about their patient care” and save so many children’s lives throughout the state, that the media should concentrate on a series called “The Saving of Our Children.”

From his files alone, the stories are never-ending:

* About the little boy whose guilty, grief-stricken grandmother might have killed herself? “By the end, they were all fine: the child, the grandmother, and the family.”
* What about the 6 year old who was only trying to come to her little brother’s rescue in the car? Six weeks after the accident and her near death on the operating room table, “she was playing with my daughter,” Catrambone recalls. “That’s one case I will never forget.”

* And the 14 year old baseball catcher? “The hospital had been reluctant to let me use a lumbar puncture to drain spinal fluid in order to relieve cranial pressure. In fact, I was told that we weren’t going to do it.” Yet, under those dire circumstances, he was given the okay and this teen experienced immediate relief. The last time Catrambone spoke to him, “He was doing very well and in a choir.” Singing, of course, is a safer bet in terms of activity than skateboarding.

* As for the little victim of child abuse he treated here at UH, Catrambone reports that she is doing fine and is still recovering. Perhaps the best news is that she has been adopted. “Her new mother is thrilled.”