Dr. (Lt. Col.) Richard Teff reviews photos taken during the surgery he performed on Sgt. Dan Powers. Photo by Daniela Vestal.
Bliss surgeon deknifes patient
Daniela Vestal, Monitor Staff
“I was in Iraq for a year so we took care of a lot of really gnarly stuff, but it was pretty strange … to see a person with a big knife sticking out of his head,” said Dr. (Lt. Col.) Richard Teff, chief of neurosurgery at William Beaumont Army Medical Center.
In July, Teff was working at a hospital in Balad Air Force Base when Sgt. Dan Powers was brought in with the aforementioned injury.
The knife ran along the bottom of Powers’ brain through an area behind his right eye that contains several nerves, veins and the internal carotid artery, which becomes the main artery to the front part of the brain on the right side, Teff said. With X-rays and CT scans, the doctors were able to tell the tip of the knife was just barely cutting the internal carotid artery.
Teff chose to remove the knife without clipping the artery on each side of the cut, as doing so could have caused Powers to have a stroke.
Teff said he fully expected the procedure to be very anticlimactic and to simply close the scalp and skull up afterward, but when Powers started bleeding it was a shock to everyone and the team had to move really fast.
“It’s one of those things we suspected might happen but I was hoping it wouldn’t … of course, we were ready for it,” said Teff. “The anesthesia people and everybody else on the operating room team was fully prepared to take care of that problem … we did the best we could, and (Powers) did very well because of that.
“Really, the surgery part of it was not that important after all that was done … the amazing thing actually was the telemedicine part that we did during his operation,” added Teff.
After the knife had been removed, and while Powers’ head was still open, Teff left the operating room and, with his partner watching over the patient to make sure nothing happened, called Walter Reed Army Medical Center and was able to get the opinion of a vascular neurosurgeon.
Vascular neurosurgeons specialize in brain blood vessels, and Teff wanted the opinion of one on whether they should clamp the blood vessels and risk Powers having a stroke or if he should be transported with the possibility of bleeding more and dying on the plane.
Walter Reed forwarded Teff’s call to the cell phone of a vascular neurosurgeon who, at the time, was driving on the Beltway in Washington D.C.
“He said, ‘Well, can you send me the images?’” said Teff. “We had done an angiogram, where you shoot dye into the blood vessel and look at it with X-rays, so we had some very good (images) that we were able to send to him.”
The neurosurgeon gave Teff a recommendation, who went back in, scrubbed his hands and finished the operation based on the plan the vascular neurosurgeon had given him.
Teff and his team intentionally caused something similar to a small blood clot to form on the artery and stop the bleeding. However, they were concerned that once Powers was on a plane, the altitude would cause the artery to open again and, being hours away from a hospital, he would bleed to death.
“(Speaking with the vascular neurosurgeon) was very important,” Teff said. “(He said), 'I think you’re safe doing that; if I were you that’s what I would do.’ Having his expertise behind us … made me feel a lot more comfortable doing it.”
Once Teff and his team finished with Powers, he was sent by plane straight from Balad to Andrews Air Force Base, Md., where he underwent a second surgery to fix the problem with his artery.
Powers continues to do well in his recovery, and Teff expects he will be one of the lucky few who are able to return to duty after a severe injury.