ATLANTA — Ethan Church, an Avery County native who underwent a risky procedure on Oct. 3 for an uncommon progression of a relatively common disease, is still recovering in the intensive care unit at Emory University Hospital
Church, 27, son of John and Kim Church of Beech Mountain, has cavernous malformations, an issue involving abnormal blood vessels in the brain. However, the malformations often cause no symptoms.
For some, bleeding from the malformations can cause serious neurological symptoms. In Church’s case, a malformation bleeding near his brain stem needed surgery to repair.
Church began working at a hotel in Glacier National Park in Montana in May of this year. Church, an avid outdoorsmen, has worked at five national parks.
On Aug. 27, Church began experiencing weakness in his left arm and a headache and was taken to a local hospital in Montana. The diagnosis at the time was a migraine. He was given some pain medication and sent on his way, but his symptoms persisted through the next day but with an additional symptom of blurred vision.
He returned to the hospital and underwent a CT scan revealing the malformation had bled. At this point Church was flown to Kalispell Regional Medical Center. An MRI at that facility confirmed the bleed while his symptoms worsened to double vision and partial paralysis. He stayed at Kalispell for nine days.
Doctors at Kalispell advised the blood would absorb into Church’s brain and the symptoms would fade, though he would require inpatient rehabilitation. He was transferred to Care Partners in Asheville on Sept. 6 where he struggled with physical therapy because of his symptoms.
On Sept. 13 his condition worsened and he was transferred to Mission Hospital in Asheville. Another CT scan confirmed the same malformation was bleeding, at which point he was transferred to Emory University Hospital in Atlanta, a hospital renowned for its neurosurgery program.
Doctors at Emory did not want to perform surgery to remove the malformation because of the location at the back of Church’s skull, believing once again the blood would be absorbed and his symptoms would improve. He was returned to Care Partners on Sept. 20. On Sept. 26 his symptoms began to worsen again and on Sept. 28 he had to be placed on a ventilator and a feeding tube after being diagnosed with aspiration pneumonia.
On Oct. 1 he was transferred back to Emory. Another CT showed the malformation had bled again.
Dr. Nelson Oyesiku, who is the residency program director for Emory’s Department of Neurosurgery and editor-in-chief of the medical journal Neurosurgery among other honors, performed the surgery to remove the malformation by passing through Church’s nose and to the back of his skull during a lengthy surgical procedure on Oct. 3.
Oyesiku said the malformation had bled repeatedly in the pons, a section of the brain stem, causing Church to suffer profound neurological difficulties as a result.
The procedure’s goal was to remove as much of the malformation as possible and the blood clot which was depressing Church’s brain stem and causing the neurological dysfunction.
“It’s a very narrow corridor, and obviously there are potential risks of going through that corridor,” Oyesiku said, noting the pathway has been used for other lesions, including these kind of malformations, but rarely.
Removal of malformations more often goes through the side or rear of the skull. Oyesiku said the route through the front is shorter and passes through mostly air and bone, whereas approaching from the side or behind involves navigating through many nerves of the brain stem that control a number of motor functions.
“It’s a high risk procedure and it’s a technically difficult procedure,” Oyesiku said. “Obviously there’s lots of room for things to go wrong and potential complications there, but from the standpoint of tolerating the surgery and accomplishing our goals, he’s tolerated well. If anything his condition is better than it was before.”
The surgery took nine hours and Church’s mother, Kim, said he was given a 50/50 chance to survive the procedure. Church did survive, as much of the malformation was removed as possible, and he is still attempting to recover at Emory.
“I told Ethan, ‘I’m sure you’re in the record book,’” Kim said. Oyesiku had never removed this type of malformation with this procedure before. Kim added that the entire ordeal has been unreal.
“He loves being outside, he loves to hike, he loves to climb rocks,” Kim said of her son. “Healthy as he could be.”
Before the surgery, Church wrote on a dry erase board the phrases “God is with me” and “peaceful.”
Speaking to The AJT a second time, Kim said the family is tired after being in Atlanta for more than two weeks.
“We just want something good to happen,” Kim said.