Flight attendant Crystal Elemendorf was heading for San Francisco International Airport early one Sunday morning in October 2001. As she shifted lanes nearing the exit, she hit a car that had been in her blind spot. She swerved suddenly back into her lane, and her small SUV rolled over. Elmendorf suffered a severe traumatic brain injury.

She was transported to the SFGH trauma center within minutes, but by then, time was running out. Neurotrauma surgeon Geoff Manley evaluated her CT scan and saw nothing but bad news. Elmendorf had blood clots, or hematomas, on both sides of her head and severe brain swelling.

To relieve the pressure caused by the bleeding and swelling of the tissue, Manley removed a section of skull about the diameter of a softball on the left side of the head, and an even larger section on the right. Elmendorf was then put into a medically-induced coma with sedative drugs to reduce her brain activity to a minimum.

"I knew the family had arrived," says Manley, "and I was preparing myself to suggest that we consider removing life support. But when I got to the ICU, I saw that someone had tucked a pair of baby socks into her hand. Knowing she had a small child, we were not ready to give up hope that we could save her life."

Manley and his team began to treat Crystal's brain swelling with a highly concentrated salt solution that they had developed from their research at UCSF. This controlled the swelling, and she started to slowly improve.

After three weeks, Elmendorf regained consciousness. She still faced many challenges. A year after the accident, the sections of her skull were surgically replaced. The left side healed normally, but the right side failed. Eventually, the right side of her skull was replaced with a precisely engineered prosthesis.

"Crystal is a special person," says Manley. "When I discuss her case with other neurotrama surgeons and show them her CT scans, they are stunned. We were trained in medical school to accept that people with brain injuries like hers would not survive, or would only survive with severe disabilities. Between the resources of UCSF, the top-notch ICU staff at SFGH, Crystal's supportive family, and her determination to raise her son, we were able to push the limits of what is medically possible."

"I'll always be thankful for Dr. Manley and SFGH," says Elmendorf. "Some hospitals would have said 'why bother?'. Dr. Manley and the ICU nurses took a chance with their time, energy and skills to save me. Many people don't realize what an amazing place the SFGH trauma center is."

Manley and his team continue to research ways to save patients with injuries such as Elmendorf’s. Reporting on their experience with Elmendorf and 12 other severe brain injury patients in the journal Neurosurgery, the UCSF/SFGH team says that their highly concentrated salt solution compares favorably to existing standard treatments and appears to have a longer-lasting effect.

Source: Michael Barnes