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T M C » P U L S E | J U LY 2 0 1 8 30 A little courage Sitting on the couch surrounded by his family, Ashif recalled the eve- ning before Umair's surgery—when he was ready to cancel everything. "The day before the surgery, they called us because they needed more blood for analysis, and I took him but thought, in the morning, we will not go back. Those were my inner feelings," Ashif said, remembering how nervous he had been. "Then I came home and [Bushra] told me we have to go. I prayed to God and I got a little courage, and now he has a new life." Umair's surgery began on the morning of Nov. 22, 2017. Rather than cut a larger incision around the top and side of the scalp, Lam made a straight, 5-centimeter incision in the skin. Through that, she created a small opening in the skull bone, about 2 centimeters by 4 centime- ters, on the top of Umair's head, where she used an endoscope to see deep inside his brain. With specialized microneurosurgi- cal instruments and what look like extra-long tweezers, Lam carefully disconnected one of the brain's hemispheres from the other in a multi-step process. This method would ensure that the frequent seizures from the diseased, seizing, left side of the brain would not spread to the healthy right hemisphere. The surgery lasted six hours. Umair's parents said that when Lam emerged from the operating room, she seemed both exhausted and elated. As for them, the surgery's success, and Umair's recovery, exceeded their wildest expectations. "We were scared the wound would remain open and his face would remain swollen for days, that the recovery would take a few months. But with this technique, the recovery is just a few days," Ashif said. "He was out of bed within a day, and he was only in the hospital for about a week. They had said one to three months and that he should have homeschooling for six months, but he was home the ninth day and in school after about a month and a half." Potential and plasticity Umair said he feels much better now that he no longer has seizures, and he is thrilled to have shed the hel- met that used to protect his head. He is working with physical therapists, occupational therapists and reha- bilitation specialists to learn how to use the right side of his brain to its full potential. Although Lam hopes Umair will remain seizure-free and that he can be independent in his daily life, she does not anticipate that he will develop fine motor skills in his right hand—something he never had because of damage from his stroke at birth. But that doesn't seem to slow him down. At a follow-up appoint- ment after the surgery, Umair excitedly told Lam a new joke he learned from friends at school, then proceeded to give her an enthusias- tic high-five with his right hand. "When one side of your brain is disconnected, sometimes you have to relearn whatever that part Sandi Lam, M.D., is a pediatric neuro- surgeon at Texas Children's Hospital who developed a minimally invasive surgical technique to treat epilepsy. e p i l e p s y t r e at m e n t s