Cardinal William H. Keeler is expected to remain in the hospital for at least three days as he recovers from surgery to allow excess fluid to drain from his brain, Archdiocese of Baltimore officials said yesterday.
"The cardinal is awake, a little groggy but in good form," said Bishop W. Francis Malooly at a news conference yesterday.
Keeler needed the surgery, the bishop said, because of a condition that might have been a complication from an October car accident while he was vacationing in Italy.
At the time, doctors treated Keeler for a broken ankle, but they believe that head trauma from the accident might have triggered normal pressure hydrocephalus - an abnormal buildup of cerebrospinal fluid in the ventricles, or cavities, inside the brain.
Though Keeler recovered from the broken ankle through physical therapy, he was still having trouble walking, the bishop said.
"There was no indication of this kind of activity, or lack of activity, prior to that accident," Malooly said.
The ventricles normally produce enough fluid to cushion the brain and spinal cord from injury. With normal pressure hydrocephalus, the ventricles balloon, stretching nerve fibers in the middle of the brain that control walking and bladder control, according to physicians.
Yesterday, pediatric neurosurgeon Dr. Ben Carson inserted a shunt, or tube, into one of the cardinal's ventricles during a 1 1/2 -hour procedure at Johns Hopkins Hospital. Neither Carson nor the cardinal was available for comment before the surgery yesterday or after the procedure.
Carson performed the procedure because the surgeon working with the adult hydrocephalus program is away for a month, said Dr. Michael A. Williams, neurology director for the adult hydrocephalus program at the Johns Hopkins Hospital.
The tubing, with adjustable valves, is usually inserted in the right side of the brain and threaded under the skin to the abdomen, where the excess fluid - up to 8 ounces a day - is reabsorbed, Williams said. Keeler's physicians will check in about three weeks to make sure an appropriate amount of fluid is being released through the shunt, Malooly said yesterday.
Williams said if too much fluid is released through the shunt, the brain itself might get smaller, creating space between it and the inside of the skull. That could tear the blood vessels that bridge the gap between the skull and the brain, causing blood clots - called hematomas - to form.
Keeler is still hoping to attend the ordinations of four new priests for the Archdiocese of Baltimore on Saturday, if his condition permits, though Malooly will perform the ordinations. "He does bounce back quickly, though - that's his track record," Malooly said.
At 76, Keeler is the average age for diagnosis for normal pressure hydrocephalus, according to medical experts. At that age, the cardinal, who has served as archbishop of Baltimore since 1989, also has reached a milestone within the Catholic Church.
When Keeler turned 75 last year, he submitted a letter of resignation to the Vatican as required by canon law. But Pope Benedict XVI has not accepted Keeler's retirement or indicated when a replacement might be named.
"We have no indication of when that will happen," Malooly said yesterday.
Cardinals are no longer allowed to vote in the election of a new pope once they reach age 80. Keeler called Archbishop Pietro Sambi, the papal nuncio and the Vatican's ambassador to the United States, last week to inform him of the surgery, Malooly said.
Before yesterday's procedure, the cardinal "was walking slowly, kind of shuffling," the bishop said. "It was almost like the signal wasn't getting to the feet."
That's a common description of the symptom, Williams said. Other symptoms can include short-term memory loss or mild dementia.
"These symptoms themselves are very common, but not everybody who has those symptoms has hydrocephalus," the neurologist said. "The challenge is to find out if any of it is from hydrocephalus, or enough to say yes," surgery is appropriate.
"The shunt isn't the hard part of the job," Williams said. "It's picking the right patient for the shunt."
Keeler's symptoms had improved after a diagnostic test several weeks ago that drained some fluid from his spine, archdiocese spokesman Sean Caine has said. Malooly said the cardinal was looking forward to the surgery.
"He was very chipper and optimistic this morning," Malooly said. "When I visited with him after he celebrated his private Mass in his house, he was anxious to get to the hospital and have the surgery, and get back moving quicker and better than he has been."
Catholics prayed for Keeler at the regularly scheduled 12:10 p.m. Mass yesterday at the Basilica of the Assumption at Cathedral and Mulberry streets.
The plush red chair normally reserved for the cardinal sat empty at the far left of the basilica as Malooly celebrated Mass and reminded those kneeling in the church to think of Keeler.
A normal noon Mass on Monday brings out 15 to 20 congregants, said Pat Walls, who works for the archdiocese and attended the Mass, but the number of worshipers swelled to about three times that number yesterday.
Congregants' concerns for the cardinal illustrate his importance in the community. "He's a very special person to us," said Carol Augustine, who works for the archdiocese in the division of evangelization and catechesis and rushed into the basilica during her lunch break.
"I always feel - I don't want to say 'holy' - but his presence is so overwhelming," said Tracy Dernoga, 33, who works in fiscal services for the archdiocese, just before stepping into the basilica. Her co-worker, Tracy Wienecke, 29, said they took time out of their day "to pray for the cardinal - and that he has a quick recovery."
Malooly and other archdiocese officials expect Keeler to aim for that quick recovery, particularly so that he can attend Saturday's ordinations.
"It's the highlight of his year," the bishop said. "He's spent so much time trying to recruit vocations for the priesthood and working with them in formation."
However, the service takes more than two hours, which might be difficult for anyone recovering from surgery, the bishop said.
"Knowing his strong will, anything he can do to get there, he'll do to make that work."
Previous coverage and multimedia at baltimoresun.com/keeler