Kendra Mitchell

Second-Grader Undergoes Complex Brain Surgery

By Abby Sinnott

At just nine years old, Kendra Mitchell is already a UCSF veteran. She received a liver transplant at UCSF when she was 10 months old due to a rare birth defect. And last year, she was treated for an unrelated, life-threatening condition called arteriovenous malformation (AVM).

AVMs belong to a group of disorders known as vascular malformations, which are conditions affecting the blood vessels in the brain. The leading cause of stroke in children, an AVM is best described as an abnormal tangle of arteries and veins in the brain.

"We were completely devastated; just when we thought Kendra was finally out of the woods, we found her right back in the thick of it!" says Kendra's mother, Lisa Mitchell. "All of sudden, out of the blue, her life was threatened by something we didn't even know she had. The brain wasn't an organ we were familiar with and it scared us beyond words."

Last year, after experiencing a sudden and severe headache and vomiting, Kendra was taken to the emergency room in her hometown of Reno, Nev. Her parents expected a diagnosis of a migraine headache, but were shocked to find out that Kendra was actually suffering from an AVM that had begun to bleed, or hemorrhage, into her brain, which can lead to a debilitating or fatal hemorrhagic stroke.

AVMs typically are caused by mistakes that occur during fetal development or soon after birth. The malformation can form wherever there are arteries or veins in the brain or spinal cord. Arteries carry oxygen-rich blood away from the heart to the body's cells and veins return oxygen-depleted blood to the lungs and heart. AVMs can rupture and bleed, causing a hemorrhagic stroke.

Kendra's doctor in Reno called her long-time UCSF liver specialist, Dr. Philip Rosenthal, who immediately made arrangements for Kendra's transfer to UCSF Benioff Children's Hospital, home to the only comprehensive pediatric stroke program in the Western United States — the UCSF Pediatric Stroke and Cerebrovascular Center.

The center's experts specialize in diagnosing and treating the most complex vascular disorders affecting a child's brain and spinal cord. The center offers the latest and most advanced treatment options, including surgery, radiation therapy, embolization and radiosurgery using a machine called the Gamma Knife. UCSF Medical Center was the first to use this type of Gamma Knife in Northern California.

"We were so happy to find out that UCSF is the place to go if you have an AVM," says Mitchell. "Once again, we were surrounded by our UCSF family—doctors, nurses, child life specialists and social workers — who took care of every one of our family's needs."

Because of the location of Kendra's AVM, doctors recommended surgery to completely remove the malformation or the Gamma Knife, an advanced radiation treatment used for AVMs, brain tumors and other neurological conditions. Despite its name, it isn't a knife, but delivers a single, very finely focused, high dose of radiation precisely to its target, while causing little or no damage to surrounding tissue. However, the Mitchell's were advised that the Gamma Knife could take two to three years of treatment before completely eliminating Kendra's malformation.

"We struggled with what treatment approach to chose for Kendra," says Mitchell. "It was the hardest decision we've ever had to make—send her into major brain surgery and risk a possible speech deficit or chose the Gamma Knife and hope Kendra didn't bleed before it was obliterated."

After discussing both treatment options in length with UCSF doctors, the Mitchells decided to have Kendra's AVM surgically removed. Dr. Nalin Gupta, chief of pediatric neurological surgery and Dr. Michael Lawton, a vascular neurosurgeon, worked together to perform the procedure, combining their expertise in pediatrics and vascular surgery to provide Kendra with optimal care.

"Kendra was in the fortunate situation of having options — she had a lesion that was amenable to either microsurgical or Gamma Knife treatment—and we have the technology available at UCSF to offer her those options," says Gupta. "Much of what we provided to Kendra's family was education — informing them of the pros and cons of the treatment options, and allowing them to make the decision that was best for them."

Mitchell says that although she was scared about her daughter's surgery, Gupta and Lawton's advice and expertise kept her positive. Her optimism proved right: she describes her daughter's recovery as "miraculous." Although Kendra's AVM was located in the area of the brain that controls speech, putting her at risk for a speech deficit following surgery, Mitchell says her daughter's speech is normal and she's still "talking everyone's ears off."

Kendra is now in second grade and busy adding to her collection of 290 rubber duckies, having fun with her sister, having sleepovers with friends, watching movies, and playing miniature golf and bowling

"The UCSF staff is simply amazing. Not only did Kendra receive state-of-the-art medical care, she was also truly cared for and loved by the staff," remarks Mitchell.

Story written in March 2007.

Abby Sinnott is a freelance writer in San Francisco.

Related Information

UCSF Clinics & Centers

Pediatric Brain Center

Neurosurgery Clinic
1825 Fourth St., Fifth Floor, 5A
San Francisco, CA 94158
Phone: (415) 353-7500
Fax: (415) 353-2889

Stroke & Cerebrovascular Disease Center
1825 Fourth St., Fifth Floor
San Francisco, CA 94158
Phone: (415) 353-7596
Fax: (415) 353-2400

Conditions Treated