Woman comes back after wide-awake brain surgery

Scan in 1983 showed four tumors that then were considered inoperable

By Sue Thomas

GRAND RAPIDS, Mich. (AP) — On request, Kim Bonnema recited the months of the year, smiled, wiggled her fingers and touched her nose.

It was a bit like a roadside sobriety test, except Bonnema was lying down — on an operating table — as a surgeon removed tumors from her brain. The simple tasks she was asked to perform showed the parts of the brain that controlled various neurological functions.

The idea of being awake during a craniotomy was frightening at first to Bonnema, a 45-year-old receptionist. But by the time she underwent surgery at Spectrum Health’s Butterworth Hospital, she was surprised how calm she felt.

“I was very relaxed,” she said. “I was just so confident.”

Dr. Kost Elisevich, the surgeon who performed the operation, said he considers “awake cases” to be part of the range treatment options available to help patients with brain tumors or lesions.

“I don’t want other people or physicians to think because a lesion is in a particular part of the brain that the patient doesn’t deserve the full benefit of having a resection done,” he said.
Bonnema, a mother of two, underwent the operation July 2 to treat two issues arising from angiomas — blood vessel malformations in her brain. She has had epilepsy for 30 years, and this summer, she developed weakness on the right side of her body.

So far, both conditions have improved since the surgery. Bonnema is hopeful she might someday be able to stop taking anti-seizure medication.

Bonnema was 16 when she began to suffer grand mal seizures and was diagnosed with epilepsy. A quiet, shy kid, she didn’t tell many of her classmates.

“The toughest part I remember was when I was in marching band and I had a seizure during practice,” she said. “Kids were saying ‘Kim is on drugs.’ I was mortified.”

A brain scan in 1983 showed she had four tumors, but at the time they were considered inoperable.

With medication, Bonnema was able to prevent grand mal seizures for the most part. But she still had minor seizures that would be difficult for others to detect. And during her two pregnancies, she had difficulty matching the right medication dose to her changing weight, and had severe seizures.

She didn’t let the condition slow her down or interfere with her life.

“I wasn’t going to let it stop me from anything,” she said. “I’m not a worrier. I didn’t think what might happen in the future. You just got to live for the day.”

Last May, however, new problems arose. Bonnema noticed weakness and numbness in her right hand. Sometimes, she stumbled when she walked.

An MRI showed there were now six tumors in her brain. Two were of particular concern, Elisevich said. A tumor in the left frontal lobe had tripled in size in eight years, growing to 25 millimeters. It was between the speech area and motor area of the brain.

“There is also a third area between those two called a pre-motor area,” Elisevich said. “It has to do with integration of movement.”

If the tumor continued to grow, it could further affect Bonnema’s control of her hand, arm and the right side of her face, Elisevich said.

The other tumor was in the left temporal lobe, an area that he said “is notorious in humans for being vulnerable to the condition of epilepsy.”

Bonnema opted to have both tumors removed. During the operation, she was aroused from sedation so her language and motor skills could be assessed. The surgeon needed to know which areas to avoid as the tumors were removed.

“We asked Kim to move her right hand and wrist, to show a smile and close her eyes,” Elisevich said.

A speech pathologist listened for any unusual features in her speech.

During the operation, the surgeon also removed scar tissue caused by blood seeping from the lesion in the temporal lobe - the one that caused the epilepsy.

“We had to peel the scar away from the nerves that go to the eyes and move the eyes about,” Elisevich said.

Although Bonnema remembers being awake during surgery, she said she was not aware of what the surgeon was doing. Elisevich gave several reports during the six-hour operation to Bonnema’s husband, Brent, and her children, Brandon, 20 and Brittany, 18.

After the surgery, Bonnema’s speech was garbled at first, and she was unable to open her right eye for three months. With time and rehabilitation therapy, she regained her ability to speak clearly and her eye function returned.

“The brain doesn’t particularly like me, nor does it like any surgeon,” explained Elisevich. “Any slight perturbation of the cortex, the gray mantle of the brain, or the white matter underneath it kind of leaves their footprint there for a time. The white matter in particular has to recover from that.”

Elisevich said he will monitor Bonnema’s other lesions. If she continues to be seizure-free for a period of time, she may be able to reduce and eventually stop taking her epilepsy medication.

“That’s great,” Bonnema said. “I’ll have more energy.”

In the meantime, she has returned to her job at Clark Home. She is again taking two-mile walks at lunch time, and her kids are expecting her water-ski again.

“It’s amazing,” she said. “It really is.”