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Riley Children’s Health
Top honoree, Physician
On a weekend night in early August 2023, four physicians at Riley Hospital for Children were thrown together on short notice to deal with a surgical problem as outlandishly complex as it was dangerous. Earlier that day, a 7-year-old girl named Olivia had been pierced in the face with a steel blow dart, which entered through her nose and lodged in the base of her skull, where it nestled in the connective tissue surrounding her brain, only millimeters from a major artery.
“I was on call at the time, so I took the first call,” said pediatric neurosurgeon Dr. Laurie Ackerman. “I uploaded scans of the injury, and I kind of swallowed hard when I saw them.”
One wrong move and the dart might nick the nearby artery, damage the brain stem, or both. Obviously, there was no playbook for such a freak injury. Ackerman quickly alerted the three other physicians who would take point on Olivia’s treatment: pediatric otolaryngologist Dr. Matthew Partain, who was also at the hospital that evening; neurosurgeon Dr. Mitesh Shah; and ENT rhinologist and skull-based surgeon Dr. Satyan Sreenath. Shah and Sreenath weren’t working that evening, but both quickly drove in from their homes.
At least the doctors had a bit of time to strategize. Olivia lives in northwestern Indiana and had to be driven to Riley via Lifeline ambulance. Though Olivia’s wound was indeed dire, she was stable and seemed to be in no immediate danger.
“I met her in the emergency room trauma bay, and she was chatting away with her mom with the blow dart sticking out of her head,” Partain said. “We had time to plan and bring in Dr. Mitesh and Dr. Sreenath to help facilitate this very complex removal.”
The team used endoscopic craniofacial surgical techniques (which are more typically employed for tumor surgery), working through the nose to loosen the dart without lacerating the nearby artery. They had only about two centimeters in which to maneuver.
“I needed to know what the tip of the dart looked like, and I had never seen a blow dart,” Mitesh said. “So while we were in surgery, we called the parents to see if we could get a picture of one.”
They quickly texted an image, allowing the team to determine how much bone around the tip had to be drilled out in order to withdraw it safely. After several hours, this was accomplished, with Olivia none the worse for her ordeal. Within days, she was back on her feet and fully recovered, with nothing to show for the terrifying incident but a harrowing story.
The case is now used as a teaching tool for collaborative surgical practices, and the four surgeons will give an oral presentation on the encounter at the 2024 North American Skull Base Meeting. The case can teach lessons about everything from teamwork to accessing until-recently-inaccessible portions of the skull. However, Ackerman fervently hopes she never sees anything exactly like Olivia’s
situation again.
“This wasn’t something you rehearse for,” she said. “We’re just very fortunate. We have really skilled people, and I’m very proud to be a member of that team.”•
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