Brain Surgeon Sees Life On The Cutting Edge

With breathtaking precision, the gloved hands cut and peeled back four pie-shaped sections of the dura - the leathery white membrane just beneath the skull.

For an instant the burly neurosurgeon’s blue-gowned shoulder blocked my view. Then I saw it, pulsing with each heartbeat beneath the brilliance of overhead lights:

The brain. The wondrous, pink-and-gray surface of a living human brain.

It was Tuesday morning inside a fourth-floor operating room at Spokane’s Deaconess Medical Center.

A few feet away, Dr. John Demakas prepared to go after a walnut-sized tumor lodged precariously in the brain of an 11-year-old boy.

What a moving experience, watching this unsung superstar saw through skull, cauterize the most delicate tissue and perform a surgical tightwire act with such casual coolness.

Demakas, 50, is a plain-speaking guy who favors cowboy boots, smokes cigars and rides a Harley. A bristly gray beard curls from the sides of his surgeon’s mask. His back is broad from years of power lifting.

As he began the search-and-destroy mission, Demakas’ words from an earlier conversation replayed through my mind: “If you take an extra inch of small intestine or liver, depending where you are, of course, you’re probably not going to cause the patient any critical damage.

“In the brain, however, we don’t have that luxury. In some areas we’re talking mere millimeters that will make a difference.”

That critical need for accuracy is why Demakas offered me this rare invitation. He wanted me to see “The Operating Arm” - a $150,000 piece of newfangled equipment that came to Deaconess last fall.

The device uses a probe hooked to the operating table and wired to a nearby computer.

The arm-like probe works much like a mouse. As the surgeon moves it around the head of a patient, the computer screen displays precisely where the probe tip is in relation to split-screen images of the patient’s head and interior of the skull.

This amazing view helps surgeons plot the best and least invasive route to a tumor. Incisions can be smaller, which means shorter hospital stays.

But even high technology is only wonderful when it works. Minutes before surgery was to begin, the arm’s movements would not register on the computer.

No cutting had been done yet. The young patient, deep under anesthesia, was in no danger. But the glitch caused a frustrating, 35-minute delay for the surgical team.

Joe Binder, a registered nurse who helped Demakas modernize Deaconess’ neurosurgery wing, called the probe’s support staff from the operating room telephone.

Because the phone wouldn’t reach the computer, Binder had to relay instructions to Demakas, who entered the data into the keyboard.

Watching this computer meltdown unfold was like tuning in on a tense “ER” episode. “That’s why I don’t watch the show,” Demakas said with a grin, “because I live it every day.”

Binder finally wheeled the arm’s computer station to his office. He would try to fix it there.

As the minutes ticked away, Demakas scrapped any thoughts of using the arm. He would operate on the boy “the old-fashioned way,” with ultra-sound.

The telephone rang. It was Binder saying the arm was fixed. “Is it too late to use it?” he asked.

After first saying it was, Demakas reconsidered. “Bring it in.”

Set up a second time, the arm worked flawlessly. Demakas, unruffled by the morning’s drama, used the probe often to check the exact depth of his journey into the brain.

If only the ending was as happy for the child.

Using a tissue-destroying aspirator, Demakas removed perhaps 80 percent of a particularly aggressive tumor. Some of the malignancy was simply too deep to remove, he said, without causing irreparable harm.

The boy is recovering and doing well, but faces chemotherapy and an uncertain future.

“You’ve got to be realistic or you get depressed all the time,” says Demakas of his pressure-packed profession. “We’re not God. We’re not miracle workers. We do the best we can and once in awhile we win.”

, DataTimes