Brain bypass helps North Dakota teen injured by shotgun blast

Dr. Eric Nussbaum has performed many bypass surgeries to reroute blood flow around clogged arteries in the brain.

But not when the blockage was a shotgun pellet.

That was the neurosurgeon's challenge Nov. 23, after a 14-year-old North Dakota boy, Kaelan Macdonald, was in a hunting accident that sent a stray pellet zipping between his left eye and eye socket to lodge inside an artery in his brain.

"This would really be a one-in-a-million type situation," Nussbaum said Monday, when the doctor and the Macdonald family celebrated the teen's discharge from United Hospital in St. Paul.

Macdonald was shot Nov. 17 while hunting with his father and two family friends in wetlands near their home in Bismarck.

At first the teen tried to be tough, telling his father they could finish their hunting sweep. Instead, he was rushed to a hospital and later experienced strokelike symptoms due to the restricted blood flow in his brain. He was flown to Gillette Children's Specialty Healthcare in St. Paul.

At one point, Macdonald awoke in a hospital bed to find he couldn't move his right arm and leg or verbalize his thoughts. His father, carrying the weight of having directed the hunting party that injured his son, was terrified.

"I've never felt fear like that," Russell Macdonald said.

Doctors at Gillette consulted Nussbaum and his colleagues at United. At first, they suspected the symptoms were caused by the pellet pushing against an artery from the outside and cutting off blood flow in the brain. Later, they confirmed the pellet was actually inside an artery, and opted for the bypass.

While Nussbaum said he has performed the delicate procedure "fairly frequently," it was tricky because the damaged artery was a "fraction of a millimeter" and the bypass vein was sewed on with thread that is finer than human hair.

"It's really quite dramatic," Nussbaum said.

Macdonald's symptoms abated soon after the procedure, and the teenager was strong enough to go home Monday. A two-inch scar on the left side of his head was a visible reminder of the procedure and the recovery still ahead of him.

Macdonald still sees double when looking far into the distance or to his left. Doctors expect his eyesight to improve. Macdonald will have to refrain from snowboarding and wrestling for a while, but he said he's grateful for the surgery and the chance to now go home and sleep in his own bed.

"It was definitely the scariest moment when I couldn't move [or talk]," he said. "Because if I can't move, everything I worked for is just gone, besides my thoughts."

Doctors debated what to do with the pellet, but decided to leave it inside Macdonald's head. Nussbaum said it didn't appear to present any risks after the bypass, and imaging scans showed tissue forming around it in order to wall it off from the brain.

Macdonald admitted it felt a little weird knowing the pellet was still inside his head.

But, he said, "If the doctors have confidence, it won't matter. I'll trust them."

Jeremy Olson • 612-673-7744