National Geographic News
A bear recovers from brain surgery.

Champa, an Asiatic black bear, recovering from brain surgery. She is the first bear to undergo such an operation.

Photograph courtesy Matt Hunt

Michelle Nijhuis

for National Geographic News

Published April 11, 2013

In the mountains of northern Laos, a three-year-old Asiatic black bear has become a medical pioneer: the world's first bear to undergo brain surgery.

The bear, named Champa, has lived most of her life at a sanctuary run by Free the Bears, an Australian nonprofit group. About 20 miles (32 kilometers) south of the city of Luang Prabang, the sanctuary protects bears that Lao officials have rescued from wildlife traffickers. The Asiatic black bear, or moon bear, whose bile is considered a valuable ingredient in traditional Chinese and Korean medicine, is listed as vulnerable on the IUCN Red List of Threatened Species.

Rescued as a cub, Champa stood out from the start: She had a protruding forehead and had trouble socializing with the other bears at the sanctuary. Over time, her growth slowed, her behavior became more erratic, and her vision faded.

Sanctuary staff and veterinarians suspected hydrocephalus, or "water on the brain," a disease that strikes humans as well as animals. It's most commonly caused by the blockage or overproduction of cerebrospinal fluid in the brain's cavities.

In most Western countries, a wild animal with hydrocephalus would likely be euthanized. "Having hydrocephalus is like having an absolutely mind-blowing, constant migraine," said veterinarian Romain Pizzi. But because of the strong Buddhist tradition in Laos and the technicalities of its wildlife protection laws, euthanasia was not an option.

So Free the Bears called on Pizzi, a South African veterinary surgeon who works in Scotland at the Edinburgh Zoo and also at a national wildlife rescue center. Pizzi uses a technique called "keyhole," or laparoscopic surgery, in which surgery is performed through a small incision and with the help of a camera.

He has operated not only on bears but also on seals, reindeer, jaguars, and other species. No one had ever done brain surgery on a bear, though, and the risks were significant—but, Pizzi and Free the Bears decided, preferable to the agonizing death Champa would suffer if untreated.

Through a Keyhole, Gently

To prepare for the operation, Pizzi consulted with pediatric surgeons and studied Asiatic black bear skulls, a replica of a bear brain, and the brains of a hydrocephalic otter and fox. He packed equipment to carry from his home in Edinburgh to Laos, knowing that he would be operating under hot, humid conditions and with unreliable electricity. Since there was no MRI machine at the sanctuary (or anywhere in Laos), he would not be able to confirm the diagnosis of hydrocephalus until surgery began.

The six-hour procedure began on the morning of February 25. Pizzi drilled a small hole behind one of the sedated bear's ears, using an ultrasound probe to confirm that Champa was in fact hydrocephalic. Pizzi then inserted a thin tube through the hole into the brain and, guided by the camera, threaded the tube under her skin to her abdomen. The tube, which will remain in place indefinitely, is designed to drain excess cerebrospinal fluid into the abdominal cavity, where it can be easily absorbed into the body.

While the procedure went reasonably smoothly, Pizzi did have to improvise: At one point, a medical pump short-circuited in the high humidity. Pizzi resorted to a mattress pump instead to keep Champa's abdomen inflated.

The operation was completed by 4 p.m., and veterinarians kept watch on Champa through the night. By 8 a.m., says Free the Bears chief executive Matt Hunt, Champa was awake and "looking like a very different bear." Before the operation, her swollen head had weighed down her neck, but now she could raise her head to look directly at sanctuary staff. "There was a lot more recognition," said Hunt. "We can't know if her vision is fully recovered, but everyone certainly believes her vision has improved."

While Pizzi doesn't expect to perform neurosurgery on a bear again anytime soon, he has already performed several gallbladder surgeries on bears rescued from Asian bile farms. Because of the ongoing demand for bear bile as a traditional medicine in China, living bears are "tapped" for their bile, with dirty catheters and needles often leaving the animals with infected gallbladders that must be removed.

Keyhole surgery is common in human medicine, and Pizzi and other wildlife specialists believe that animals also benefit from its shorter recovery time and reduced risk of infection. Animals who undergo keyhole surgery are far less likely to tear open their own incisions through scratching or grooming, for example, and are able to return to normal activities much more quickly. However, because keyhole surgery is more expensive than traditional surgery, and requires specialized training and ongoing practice, Pizzi is one of only a handful of veterinarians who use the technique in wildlife surgery.

No matter the species or the organs involved, Pizzi says that every procedure gives him a chance to test his techniques, helping him lower the risks for future patients. That's especially important for animals from extremely rare species, for which the loss of one individual can make the difference between survival and extinction. "We are all learning, and when we need these skills we will really need them," he said. "There are some very endangered animals out there that we won't get a chance to learn on."

Her Headaches Are Gone

Six weeks after the operation, Champa is markedly more active and more social with other bears, and she is gaining weight. She will always have some brain damage, since the accumulated fluid does cause permanent harm. And she will remain in captivity. But her relief is obvious.

"Operating on one bear won't save bears from extinction, and making life better for one bear won't change the world," said Pizzi. "But the world of that one bear is changed forever."

 

23 comments
Helen Bowen
Helen Bowen

Absolutely amazing, I had Hydrocephalus at birth, now 42, three shunts later and an anti syphion devise. So cool, I can sympathise with the headaches, sickness, and very random comments from general public when I was at my very worst... Hope she is still doing well xx

Alec Sevins
Alec Sevins

They go to all this trouble, while low-lifes gun down baited bears for fun on YouTube. What a world this is.

Jennifer Bozarth
Jennifer Bozarth

I just wanted to say that your story lead is incorrect.  A shunt does not cure hydrocephalus.  It is a treatment that while it is working is wonderful, but shunts fail all the time requiring emergency replacement surgery.  I just wanted to point that out. My daughter has hydrocephalus and has a shunt.  I am very glad this was an option for Champa and hope she gets many years of relief from it.

Peace Seeker
Peace Seeker

Wonderful!!

Also see the Asiatic black bears' remarkable adaptation to wilderness in the heart of mother nature and mystery about the hibernation of wild animals is solved by the hibernation study of Asiatic black bears.

http://www.cultureunplugged.com/play/7166

p d
p d

beautiful

Julie Domeny
Julie Domeny

Yeah~!  Wonderful.  Humans doing the right thing. 

Jordana Quezada
Jordana Quezada

"Operating on one bear won't save bears from extinction, and making life better for one bear won't change the world," said Pizzi. "But the world of that one bear is changed forever."

Love the quote. :)

Leonardo Alenizi
Leonardo Alenizi

What a beautiful story. What amazes me is that so called "superior" western countries would not show the compassion that dedicated Laotians did. Its little victories like these in the face of overwhelming atrocities that keep many of us going.

Sara Lay
Sara Lay

@Jennifer Bozarth Keyhole is a different type of surgery that does not use a shunt...they fenestrate openings to allow flow.  Champa apparently had a different type of hydrocephalus than your daughter.  Not being argumentative, just informative! I hope your daughter does well and I hope every day at work that they find more permanent solutions for hydrocephalus that requires shunts.

Todd Brown
Todd Brown

@Tim Schaeffer I would like to believe that humans have more control over their destiny than the animals of the world.

I am always amazed by dirt poor people living in deserts with little food or water, but having far too many children, bringing them into a life of misery.  Do not think my compassion is not there but there are so many problems anyone trying to make the world a better place for another is OK by me.

Ryan Malick
Ryan Malick

@Tim SchaefferShould we not help animals in need because there are children in need also? It is impossible to save/help every person or animal on the planet, but people can do their part and if that is by helping a bear then so be it. Animals deserve to be treated and cared for just as much as humans. Why bring negativity to such a great story..

Alec Sevins
Alec Sevins

@Tim SchaefferPeople have a massive overpopulation problem (80 million annual net gain) which is constantly destroying habitat that other species once roamed, directly leading to the need for wildlife sanctuaries. Don't confuse perpetrators with victims, be they passive or not.

Ella W.
Ella W.

@Tim Schaeffer ... I'm wondering suddenly how many children YOU have saved, let alone bears, tigers and other living beings.  You're probably worried that between the bear and you, 'they' would choose to save the bear.  Right?  Right!  Come on, don't be shy, just admit that you would like some attention, too. :D  It's normal, don't worry.  After we're done with the bears, it'll be your turn.

Andrea Ferloni
Andrea Ferloni

@Tim Schaeffer the story is posted is very sad, and a more than a billion human beings suffer hunger daily while good food goes to the trash everyday. We are living under the hegemony of capitalism, and these are some of the consequences. However, your comment is wrongly placed here, as you do not show the nexus between the article and your argument. Besides, overcoming capitalism passes also through a different treatment of animals and nature in general.

Irwin Barker
Irwin Barker

@Tim Schaeffer      I amone of many humans living with this same condition. There Are several Hydrocephalus Sites that we correspond on. Everyone has a different problem. some infants an older adults are affected.

Alec Sevins
Alec Sevins

@Leonardo Alenizi  If they really want to save these bears, Asian nations would boost their use of human birth control. Habitat destruction is the prime cause of extinctions, plus hunting aka poaching.

Tia Penrod
Tia Penrod

@Sara Lay  A Keyhole surgery is a "Less invasive" shunt surgery.  A shunt is still inserted and a shunt is not a cure it is a treatment.  There are only two ways to treat hydrocephalus, a shunt or an EVT.  An EVT is done by drilling holes at certain area's of the brain to allow the CSF to flow and be absorbed by the brain while a shunt diverts the CSF to another area of the brain to be absorbed.  Both can fail which can be deadly.  Surgeries to treat hydrocephalus cost $100 million dollars a year in the United States alone.  It is far from a cure It is just a different way to insert the shunt.  People who live with hydrocephalus face multiple brain surgeries throughout their  lifetime. My child is 7 and has had 4 brain surgeries to treat her hydrocephalus. If this was actually a cure don't you think they would be pushing to get is useable on humans to save these children from having so many brain surgeries.

Jan Vones
Jan Vones

@Andrea Ferloni @Tim Schaeffer Under the hegemony of Capitalism you are free to do what you like ith your time and money to help others.  What's stopping you?  Or is it that you want other's time and money to direct as you see fit?

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