CHOC Experts Provide High Level of Care for Brachial Plexus Surgery

CHOC offers the highest level of care for children requiring brachial plexus surgery.

Brachial plexus surgery is a complex procedure that repairs damage to the bundle of connected nerves in the neck region. Damage to these nerves is often caused by birth complications, contact sport collisions and automobile accidents. A severe brachial plexus injury can cause a patient to lose function and sensation in their arm, impairing their ability to perform everyday tasks.

Surgical procedures such as nerve grafts and transfers can restore this function and sensation and help the patient regain their lost quality of life.

“While many patients will regain movement with therapy alone, a small percentage will require nerve surgery,” says Dr. Joffre Olaya, pediatric neurosurgeon at CHOC. “Patients may even need a series of surgeries,” he adds. “The first surgery may be focused on the nerves, where the second would be focused on the transfer of muscle or movement of bones.”

The experienced multidisciplinary team at CHOC is fully equipped to handle all aspects of the repair and guide the patient and their family through every stage of treatment and healing. The surgery is performed in the Tidwell Procedure Center at CHOC, which features seven operating rooms and advanced technology and information systems.

“We like to evaluate patients as early as possible,” says Dr. Amber Leis, a CHOC and UC Irvine plastic surgeon. “We want to be part of the child’s journey and provide long-term care to ensure the best possible outcome.”

Whether or not these patients end up requiring surgery, they all benefit from therapy, explains Dr. Leis. CHOC is proud to offer the latest, research-based physical therapy in one of the most comprehensive rehabilitation centers in the area. Further, depending on their age, diagnosis and treatment plan, some brachial plexus patients may benefit from aquatic physical therapy, which takes place in the center’s pool.

Dr. Olaya and Dr. Leis are committed to building a robust, one-of-a-kind brachial plexus program for children in the region and beyond.

They offer community physicians the following guidelines on when to refer:

  • As early as possible, after a brachial plexus birth palsy with impaired arm movement.
  • After a sports or motor vehicle accident with impaired arm movement or sensation.

Learn more about surgical services at CHOC.

Complicated Case: Hemispherectomy Follows Frontal Lobe Hemorrhage

Heidi Sexton knew her young epileptic daughter, Kara, needed more help. Anti-seizure medications didn’t help, hospital visits were frequent, and seizures and tantrums continued.

“It was time,” Heidi recalled. “I went in to the next doctor’s appointment with my questions: What else can we try? This isn’t working.”

Dr. Mary Zupanc, director of CHOC comprehensive epilepsy program, offered her recommendation: Kara needs brain surgery.

A little girl’s long road

Though no doubt a staggering consideration, brain surgery would be the next landmark on a long medical history that belied Kara’s short three years of life.

At just 13 months old, she underwent emergency brain surgery after her frontal lobe hemorrhaged, caused by a previously undiscovered vascular malformation. The hemorrhage in Kara’s brain led to right-side hemiplegia, leaving her no use of her right hand and limited the use her right leg.

Kara underwent physical therapy and began walking at age 2. Life was relatively normal for the Sexton family until just after Kara’s third birthday, when she began acting strangely.

Kara’s body would stiffen, she’d fall down and stare off into space, Heidi recalled. It wasn’t until a visit to the Julia and George Argyros Emergency Department at CHOC Hospital that the Sextons would learn Kara was having seizures.

At the CHOC Neuroscience Institute, Kara underwent an electroencephalogram, or EEG, a test that monitors for electrical activity in the brain. Next, she spent six days undergoing long-term video EEG monitoring. From there, Dr. Zupanc, also CHOC’s neurology division chair, made an official diagnosis of epilepsy and prescribed an anti-epileptic medication.

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Exploring other options

Nonetheless, Kara’s seizures continued. Kara’s three older siblings were acutely aware of their sister’s disorder, daily counting Kara’s seizures and agonizing over each hospital visit. The family began to placate Kara in hopes of staving off outbursts and tantrums, Heidi said.

“Kara had between two and four seizures a day,” she said. “It really messed with her behaviorally. She’s a lovely kid, but she suffered serious temper tantrums. It was physically and emotionally exhausting.”

A second six-day monitoring session led Dr. Zupanc to change Kara’s medication and, as a precaution, begin evaluating her as a candidate for epilepsy brain surgery.

Further tests and scans revealed that the left hemisphere of Kara’s brain was significantly injured and atrophied – likely related to her earlier hemorrhage. In addition, Kara’s new anti-epileptic medication wasn’t working.

Dr. Zupanc concluded that the next step was a hemispherectomy, a surgical procedure in which one side of the brain is removed or disconnected.

“On scans, Kara’s hemisphere was completely white,” Heidi said. “The only thing her left hemisphere was doing was causing seizures. There was no question.”

A change of course

Nearly 11 months after the seizures first surfaced, Kara underwent surgery at CHOC to remove a portion of her brain’s left side, and disconnect the remaining portion from the right hemisphere. Performed by neurosurgeon Dr. Joffre Olaya, the procedure lasted six hours.

After 16 days recovering in the hospital’s pediatric intensive care unit, Kara went home just after her fourth birthday.

Much to her parents’ and siblings’ relief, Kara hasn’t had a seizure since her surgery eight months ago. Kara still relies on an anti-epileptic medication, but she may be able to stop taking it completely or use a lower dose of medication soon if her progress continues.

Though considering a second brain surgery was daunting for the Sextons, Heidi and her husband knew the procedure was the right choice to help their daughter.

“I looked at it in a sense of quality of life for Kara,” Heidi said. “Hopefully now she’ll be able to drive one day. Continued seizures would have impaired her cognitively forever, and I didn’t want that.”

Though she still requires extensive care, Kara is doing well physically and emotionally and is looking forward to preschool.

Kara isn’t fully aware of her journey in the last year, but she understands the meaning of the scar on her head just above her ear.

“She knows now that she doesn’t have seizures and Dr. Olaya and Dr. Zupanc fixed her,” Heidi said.

In the Spotlight: Joffre Olaya, M.D.

Dr. Joffre Olaya performs the full range of pediatric neurosurgical procedures, including epilepsy surgery. He joined CHOC earlier this year after completing pediatric neurosurgery and epilepsy neurosurgery fellowships at Children’s Hospital Los Angeles and Seattle Children’s Hospital, respectively.


Dr. Joffre Olaya had his eye on CHOC long before coming here. During his pediatric neurosurgery training, he became increasingly interested in epilepsy surgery. And he was impressed by what he heard about the CHOC Comprehensive Epilepsy Program, the only children’s hospital program in California to receive the prestigious Level 4 distinction from the National Association of Epilepsy Centers.

But first, Dr. Olaya decided to complete an additional fellowship in epilepsy surgery through the University of Washington at Seattle Children’s Hospital. In March 2014, he joined the CHOC medical staff and performs the full range of pediatric neurosurgical procedures, including the treatment of brain/spine tumors, cerebrovascular lesions, chiari malformations, neural tube defects, craniosynostosis and hydrocephalus, as well as intractable epilepsy.

Dr. Olaya is further developing the CHOC epilepsy surgery program, working closely with the other pediatric subspecialty services, and continuing to foster a multidisciplinary approach for optimal patient care. He is interested in the leading-edge technology that is making pediatric neurosurgical procedures safer and less invasive.

“I am particularly interested in the use of endoscopic techniques for treating hydrocephalus and craniosynostosis, as well as laser ablation for tumors and focal epilepsy,” said Dr. Olaya.

Dr. Olaya’s interest in treating epilepsy was sparked by a landmark article he read during his residency training.

“A randomized controlled trial showed that for patients who failed two medications, surgical treatment of epilepsy resulted in much greater seizure freedom compared to medication alone,” Dr. Olaya said. “I realized that for a select group of epilepsy patients, I could make a huge impact in their lives by offering them surgery.”

Dr. Olaya’s clinical interests encompass other neurological disorders, as well. His research on deep-brain stimulation for treating childhood dystonic cerebral palsy was published in the Journal of Neurosurgery: Pediatrics October 2014. A related study on this topic was recently presented at the Pediatric Neurological Surgery Annual Meeting in Toronto and published in the November 2013 issue of Neurosurgery Focus.

This past April, Dr. Olaya presented his research into the use of resting-state functional connectivity MRI to assess memory lateralization in pediatric epilepsy surgery patients at the American Association of Neurological Surgeons Annual Meeting. He is currently working on a CHOC institutional review board-approved study evaluating the use of helmet therapy for treating plagiocephaly.

Dr. Olaya is a graduate of the University of California at Davis School of Medicine. He completed his neurological surgery residency at Loma Linda University Medical Center. As a resident, he also performed an elective rotation in pediatric neurosurgery at Children’s Hospital Los Angeles. He is an assistant clinical professor in the Department of Neurosurgery at UC Irvine School of Medicine.

Fluent in Spanish, Dr. Olaya has privileges at CHOC and CHOC at Mission Hospital. He is in practice with Dr. Michael Muhonen and Dr. William Loudon at CHOC Specialists in Orange.

For more information or to arrange a referral, please contact Dr. Olaya at 714-835-2724.