By Anna Michael
The Cincinnati Enquirer

An innovative procedure removed a tumor from deep inside the brain of Caleb Madison, 9, seen here with his mother, Amanda McNeely, at Cincinnati Children's Hospital Medical Center. The Cincinnati Enquirer/TONY JONES

Nine-year-old Caleb Madison wants to be a baseball pitcher, or maybe a shortstop. But when the Crescent Springs child was diagnosed in February with a deep brain tumor, his dreams were in jeopardy.

Caleb had a tumor on his thalamus, which is a relay station for all sensory and motor functions. Without a new procedure developed by Dr. Kerry Crone at Cincinnati Children's Hospital Medical Center, it would have been inoperable because healthy brain tissue would likely have been damaged in surgery to get at the tumor.

The only treatment would have been chemotherapy, and there was no guarantee of success.

Crone's procedure combines the latest digital imaging with a technique that uses a balloon catheter to open a pathway for the surgeon to operate deep within the brain.

On March 2, Caleb underwent Crone's sixth, and most invasive, surgery using the procedure he named SMART surgery (Specialized Minimal Access Resection Techniques). It is one of several procedures offered by the Minimally Invasive Neurosurgical Division at Children's Hospital.

Crone first performed the procedure in 2002. However, the imaging was not as complex because the hospital had not yet installed the MRI scanner that uses the strongest magnetic field strength approved by the U.S. Food and Drug Administration for clinical scans. The MRI is 70,000 times more powerful than the earth's magnetic field.

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Children's Hospital is the first national pediatric institution and first hospital in Ohio to install this MRI scanner.

Crone's extensive research of pediatric neurosurgery and access to the scanner allowed him to develop the procedure over several years.

"It's the fusion of technology and surgical technique," Crone said.

Crone used the MRI scanner to take numerous images of Caleb's brain. To help him detail the location of Caleb's motor functions, Crone had Caleb tap his right and left fingers while the MRI images were being taken. Red and green spots were visible, giving Crone a good map of Caleb's brain and places that the surgeon had to avoid.

The images from the 3-Tesla MRI scanner were examined to determine which path to the tumor would be the least invasive. Because images showed the neurofiber tracks coming in and out of Caleb's thalamus, Crone was able to avoid the fibers when he inserted the balloon catheter. The balloon was then inflated over the course of five days to create a pathway to the tumor.

When the pathway was large enough to remove the tumor, Crone deflated the balloon through the quarter-sized incision in Caleb's skull and surgically removed the entire tumor.

"I think he is cured from it," Crone said.

Caleb's tumor was discovered by accident. Radiologists examining a sinus scan that was performed for an eye infection saw a dark spot in the image of his brain.

"A few more inches on the scan and this would have been missed," Crone said.

Amanda McNeely, Caleb's mother, said the ordeal was trying, but she was proud of how well her son did.

Caleb spent five nights in the hospital, and will return to school after spring break.

"I was rather worried (about how he would react), but he took it all in stride," McNeely said.

Caleb said he was little scared when he heard about the tumor, but he knew he would be OK.

He said he had a lot of support from his classmates at River Ridge Elementary.

"I think some students were jealous I got to miss school," Caleb said.

E-mail amichael@enquirer.com