Surgeons detail how they saved helicopter victim

Medical specialists described yesterday how they removed half of the skull of helicopter blade victim Johnny Lowe to save his life.

Auckland City Hospital head of intensive care Tony Smith said Mr Lowe's case was never a hopeless one, although the injuries he received on Boxing Day could have killed him.

"He has done exceptionally well from a devastating injury. I think it's a very good story to tell, because it's unusual - you don't see people hit by helicopter blades every day - and he has made a very good recovery from what was a nasty injury."

The force of the rotor blades had burst a blood vessel that sat between the brain and skull, Dr Smith said.

"When that happens there's nowhere for the brain to go, because the brain is enclosed inside the box, the skull.

"That pressure of blood collects like a large lake on the outside of the brain, underneath the skull, and pushes on the brain.

"He had a huge collection of blood which was pushing on his brain to the point that his brain was pushed right across to the other side.

"And in fact he was showing signs that the brain was beginning to lose its blood supply because the pressure inside the skull was so high that the blood couldn't get inside the brain.

"So he needed an emergency operation to relieve that pressure and stop the bleeding."

The procedure took less than four hours and was led by surgeon Dr Ashok Asthagiri.

Doctors removed about half of Mr Lowe's skull to create room for the swelling. It is being preserved and will be stitched back on in about 12 weeks' time.

"It's a bit like taking the top off a hard-boiled egg, letting the egg swell out through the hole, and then waiting for the swelling to go away and then putting the piece of egg back" Dr Smith said.

The operation was "very similar" to the technique being used in the Decra trial, a medical procedure being tested in Australian and New Zealand hospitals.

The aim of the trial is to compare the early surgical procedure with the more traditional methods of managing severe head injury.

Wellington schoolboy Andrew Girdlestone's life was saved by the procedure in October 2003, when he was severely injured after a train clipped his bicycle.

His father Roger told the Herald that his son had completed two half-marathons since and was a 17-handicapper in golf.

Mr Lowe was not a candidate for the trial because of the large collection of blood inside his brain.

Dr Smith said in Mr Lowe's case it was the side of the skull that was removed, rather than the front part.

"We've got another patient in the unit at the moment who's in the [Decra] trial," he said.

"What we don't know is whether in the long term doing that removal of the bone actually produces more good survivors or just ends up producing more badly brain-damaged people who live."

The procedure had been around for some time but was being used more often than five years ago.

"We're confident that in some patients it produces a dramatic reduction in the pressure inside the brain. What we don't know is whether or not it improves long-term survival and long-term quality of outcome. And that's the reason for the randomised trial."