Woman Doesn’t Let Brain Tumor Surgery Slow Her Down
University of Chicago Medicine experts help solve complex brain tumor case
It seemed like a typical summer afternoon for Ann Barth. After working at the Downers Grove North High School library, she joined her husband, Roger, for a run in a forest preserve near their Wheaton home. The couple had dinner and Barth made a quick trip to the grocery store to pick up a few things.
“While pushing my cart down the frozen food aisle, I passed out, fell down and whacked my head on the floor,” Barth said. She attributed the accident to being dehydrated at the end of a busy and hot August day.
A bump the size of a goose egg developed on the back of Barth’s head. Although there were no other symptoms, she and her husband went to the emergency room. A healthy and active 49-year-old, Barth was shocked to learn an MRI revealed a meningioma at the base of her skull.
Meningiomas are common brain tumors that form in the membranes (meninges) surrounding and protecting the brain and spinal cord. While most meningiomas are not malignant and many do not require treatment, they can cause considerable symptoms if they grow and press on adjacent structures of the brain. Skull base meningiomas are especially problematic because the anatomy of the area is intricate and complex.
In addition to consulting a neurosurgeon in the far Western suburbs, Barth asked her family physician for advice. “He told me, ‘You need a second opinion; after all, this is your brain,’” Barth recalled. Her physician recommended Rimas Lukas, MD, a neuro-oncologist at the University of Chicago Medicine.
During Barth's initial appointment at the medical center, Lukas brought in Patrik Gabikian, MD, a neurosurgeon with expertise in the treatment of skull base tumors.
“They took 90 minutes to explain everything about the tumor,” Barth said. “My husband and I understood the complexity of it all. As we walked out of the appointment, we said, ‘Let’s go with these guys.’”
Location Is Everything
The meningioma measured greater than 1 inch in diameter and resembled the shape of a broccoli floret. Sitting almost 2 inches deep on the left side of Barth’s skull base, it rested in an intersection of critical blood vessels and cranial nerves that pass through the sphenoid bone, the most complex bone in the human body. The tumor was compressing her carotid artery and displacing her optic nerve.
“With meningiomas, it’s all about where they are located,” Gabikian explained. “This one was in an area of the brain that’s as busy as O'Hare airport during the holidays.” Although Barth didn't have any neurological symptoms or trouble with her vision, the tumor's position put her in danger for developing seizures and visual difficulties.
Gabikian and Lukas explained to Barth that she had three treatment options: wait and watch, undergo radiation treatment, or have the tumor surgically removed. They recommended surgery, but encouraged Barth to take some time to consider her options. Worried about the mass effect on adjacent brain structures and concerned the tumor might grow, Barth soon decided to go forward with the operation.
It Takes a Team
Within a week of the appointment, Gabikian and Lukas presented her case at Neuro-Oncology Tumor Board, a weekly neuroscience meeting that brings together experts in neuro-oncology, neurosurgery, radiation oncology, neuroradiology, and neuropathology. The physicians discuss cases, share viewpoints and weigh the pros and cons of different brain tumor management plans.
“Each of these specialists brings incredible expertise to the table,” Lukas said. “Our multidisciplinary approach is a defining strength of the neuroscience program here. We work together as a team for the benefit of our patients.” The group agreed that surgery was the best treatment approach for Barth.
Microsurgery Brings Maximum Results
Gabikian performed Barth’s six-hour surgery in late September. After carefully removing portions of her skull and orbital bone to expose her skull base and brain, Gabikian used microsurgical instruments to create a safe corridor to the tumor. With the aid of a high-powered microscope that magnified the surgical field and an advanced laser that allows precise cutting, he gradually and completely removed the tumor. Following tumor resection, the skull, orbit, and facial muscles were replaced in a functionally and cosmetically accurate manner.
Barth was up and walking the day after her surgery. She remembers having discomfort, but no pain. Follow-up MRIs have shown no evidence of the tumor.
“Ann’s outcome could not have been better,” said Gabikian. “She experienced no visual loss, no neurological deficit and no cognitive dysfunction as a result of the tumor or surgery. She returned to her job and to her life.”
Barth says she feels great and is running in the woods with her husband again. “I realize now that I was tired last summer. Jogging is so much easier without a brain tumor.”