'New skull' helps teen survive severe head injuries from ski accident

In January, Tony Geistkemper was skiing on a seventh grade class trip when he hit an icy patch that sent him head-first into a tree.

The injury was so severe, physicians at University of Iowa Children's Hospital, located at UI Hospitals and Clinics, would have to take the type of heroic and innovative medical measures that illustrate why many of them are tops in their fields.

On the ski slopes, the 12-year-old was unconscious and having seizures when he was rushed to Mercy Medical Center in Dubuque. Emergency room physician Michael Zeman, M.D., and pediatrician Keevin Franzen, M.D. (a 1976 graduate of the UI College of Medicine), of Dubuque Pediatrics, immediately determined Tony had a serious brain injury that required highly specialized care.

While the physicians evaluated Tony, his father, Mark, received an urgent call from his wife, Lori, telling him their son was being read his last rites. Mark raced to be by Tony's side with Lori, their oldest daughter, Liz, and Tony's twin sister, Tricia.

At this point, Zeman and Franzen recommended Tony be taken to University of Iowa Children's Hospital by Air Care helicopter to meet with trauma team specialists like neurosurgeon John VanGilder, M.D., and pediatric intensivists, Jeffrey Lobas, M.D. and Erik Edens, M.D.

Tony's swelling worsened and physicians determined drastic measures would be needed or the pressure on his brain would kill him.

VanGilder performed a decompressive craniectomy, in essence, removing the front quarter of Tony's skull from ear to ear and down to the eyebrows. It was the only way to give Tony's brain the room it needed to continue swelling.

"The doctor told me it was an uncommon surgery," Mark said, "that they just didn't do it very often. Then he said, 'I can't give you any predictions on the outcomes. We just have to try this.'"

Clinging to life after a six-hour surgery, still unconscious, Tony was placed on a respirator and moved into the Pediatric Intensive Care Unit where Lobas and Edens again took over. During the next two weeks the swelling got much worse, and then slowly better, until Tony regained consciousness and was taken off the respirator. Soon after, he started rehabilitation to learn to speak and walk again.

Tony still had no frontal skull bone and was required to wear a helmet at all times, even after he had returned home to Dyersville, Iowa and completed rehabilitation at the local hospital.

Over the next months, Tony continued to have regular visits with VanGilder and his team who had saved Tony's skull bone, frozen it and then used it to make an acrylic mold. When they felt Tony was ready, they operated again, implanting the "new skull" into Tony's head.

Just months after the surgery, Tony was back playing Little League baseball. This fall, he started eighth grade and even returned to the soccer team his father coaches.

Michael Kelleher, M.D., director of the Neonatal Intensive Care Unit, said Tony is an example of how resilient the body can be in head trauma cases.

"But having said that, Tony is definitely the best outcome from the worst case of head trauma I've ever seen," he said. "To see him come back to visit the ICU, walking and talking, after the type of injury that most patients die from, it's just unbelievable."

His parents agree.

"It's a miracle," said Lori. "There were so many good people that helped Tony at the hospital. And now we've gotten all the progress reports from school, and he's doing wonderfully. We're just so happy to have our family back together again."

Tony Geiskemper's many activities include playing soccer team with twin sister, Trisha.

"Tony is definitely the best outcome from the worst case of head trauma I've ever seen. To see him come back to visit the ICU, walking and talking, after the type of injury that most patients die from, it's just unbelievable." --Michael Kelleher, M.D.