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Free to fly: Delicate brain surgery cures pilot's debilitating headaches

In her hands Karen Friedman cradles a baby raccoon she named Cheyenne. Ousted from someone's attic, the tiny creature is a survivor, just like Friedman. In 2000 Friedman contracted California encephalitis, developed a brain abscess and fell into a coma. After surgery she came out of the coma, but her ordeal continued for nearly two years. Dr. David Pearson, an otolaryngologist at Mayo Clinic in Jacksonville, performed a delicate surgery in the center of her skull that stopped the pain that threatened to permanently ground her.

Friedman is a state and federally licensed wildlife rehabilitator. Her passion is taking care of sick and injured animals, particularly birds of prey. She's also a third generation pilot who helps manage the family's flight school. "I work with wild animals; I fly airplanes; I ride a motorcycle; I slalom ski, and I get taken out by a mosquito," Friedman jokes.

After surviving a deadly viral infection and sinus complications, Karen Friedman is living life again.

No one was laughing, though, the night Friedman lay unconscious in an intensive care unit. She was one of four people in Northeast Florida that year to contract California encephalitis, a viral inflammation of the brain that can be transmitted to humans through insect bites. Two people died; Friedman nearly did.

A nurse asked Friedman's mother if she was prepared to take Friedman off life support. Marilyn Rabe said no. She and Friedman's pastor and members from her church surrounded Friedman and prayed.

"I could never describe it in words," Friedman says about her experience. "It felt like someone wrapped wings around me. I remember being in this brilliant, beautiful place and not wanting to leave. I could hear people talking to me. I could hear my husband saying, 'Please come back! Please come back! We need you, and the boys need you.' My sister was crying. My children were crying. But it was so beautiful, and I didn't want to go. And I just remember a voice saying, 'It's time to go back, you're not finished yet.' Within seconds of them anointing me with oil, I began to move."

Friedman with daughter, Sierra.

Surgeons had removed as much of the brain abscess as they could and prescribed antibiotics to clear up any remaining infection. Friedman recovered but says she never felt completely well. When the debilitating headaches returned, she was treated with pain medication and antidepressants. She stopped working at the flight school and reluctantly referred most of her wildlife rescue calls to others. Friedman 's mother, sister and doctor persuaded her to go to Mayo Clinic.

"She was continuing to have what are called vertex headaches, meaning right at the very top of her head," Pearson says. "That's the typical location that inflammation in the sphenoid sinus will present itself."

The sphenoid sinus is an air space about the size of a golf ball located in the center of the skull. It's normally divided into a right and left half by a bony partition. A CT scan revealed Friedman had a third, or middle compartment. The left and right sides were open and healthy. The middle was full of infection. "You'd have no idea, short of a scan, that there was this central compartment," Pearson says. "What made that more vexing was you could see it on the scan, but it wasn't obvious when you looked at her with an endoscope how to get into that safely."

Pearson scheduled surgery. His challenge was to open the infected cavity, clean it out and make a way for it to drain through Friedman's nose. "One of the problems of operating where there are bony partitions that separate where we need to go and where we don't want to go is we can't see on the other side of that wall," Pearson explains. "Nobody wants to put a 3,000 r.p.m. microdebrider through a piece of bone and find the brain on the other side. They want to find just the sinus."

Friedman understood the risks of the surgery — spinal fluid leaks, brain injury, blindness, hemorrhage — but she readily agreed. "Anybody can take pain in small increments, meaning a day or two, but when it goes into a year, I don't even want to think about it. It was that bad," Friedman says. "Anywhere I could have gone had to be up."

To assist him, Pearson used an image-guided surgical navigation system that tracked the instruments in his hands on a three-dimensional computer reconstruction of Friedman's CT scan. "The image guidance system is a stunning piece of technology that's come a long way in the last five to six years," Pearson says. "It's the closest thing we have to giving us X-ray vision. It accurately locates the tips of my instruments to within 1 millimeter of where they actually are."

Friedman woke up from surgery and felt immediate relief, and she's not had a headache since. And there's more to the happy ending. She and her husband have two sons. Because of her medical problems, they'd given up the idea of having any more children. On her birthday following surgery, she found out she was pregnant. Now in addition to her boys, Cheyenne and the 13 other wild animals she's currently nursing back to health, Friedman has a new daughter, Sierra, under her wing.

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