A "Carnegie Hall Performance"

Complex surgery to remove tumor restores vision

Removing a brain tumor is never simple. But faced with a large tumor in a nearly inaccessible region abutting crucial nerves and blood vessels, only skilled and experienced teams can expect to remove the growth with minimal side effects.

Maybe she just needed glasses was Diane Maciorowski's original thought. While applying eye makeup in the morning, she noticed blurred vision when she closed her left eye, and booked an appointment with her optometrist. While there, eye chart and field vision tests proved difficult when Maciorowski relied on her right eye.

An MRI scan of Maciorowski's tumor before surgery (left) and after (right) An MRI scan of Maciorowski's tumor before surgery (left) and after (right) Awad's team removed the entire meningioma from the skull base.

Concerned, the optometrist sent Maciorowski to a neuroophthalmologist, who recommended an MRI scan. The images revealed a somber source for her vision problems: a tangerine-sized meningioma at the base of her brain, pressing down upon her right optic nerve. Although the tumor was very likely benign, Maciorowski was told it would have to be removed. The tumor was too large, and the vision too impaired to be treatable with focused radiation treatments or other less invasive techniques.

"It all happened very fast," said Maciorowski a 56-year-old teacher and mother of three from Northbrook. "I was scared and surprised. I remember him saying it was the size of a tangerine, and I thought 'wow, that's big.'"

For the surgery, the neuroophthalmologist recommended Issam Awad, MD, Professor of Surgery and Director of Neurovascular Surgery at the University of Chicago. Maciorowski's tumor was one that was particularly difficult to remove, requiring experience and expertise in Awad's specialized field.

"Any surgeon will tell you the risks, but Dr. Awad told us, 'Whatever comes up we'll be there and take care of it,'" Maciorowski said.

"It was a difficult problem, incredibly complex, and quite risky," Awad said. "If you look at where the tumor grew under the brain, you can't have a more delicate area. Skull-base tumors grow in a very strategic place where everything around them is critical and important. A risk of stroke, a risk of blindness or a risk of not taking it all out and leaving a whole lot of tumor there -- all of those were our challenges."

The carotid artery, one of the primary blood vessels to the brain, was completely encased in the large tumor, Awad said, and the right optic nerve was being stretched thin by the growth.

"The optic nerve is normally round and hers was more like a linguini, flattened out by this tumor," Awad said.

For optimal cosmetic result, a small incision was planned near Maciorowski's sideburn and behind her hairline to create a bone opening above and behind the eye. The tumor was approached under the brain, with doctors gradually coring out and peeling away its fragments from tiny and delicate blood vessels and the thinned out optic nerve. Because of the delicate structures around the tumor, Awad said there was a chance that some of it would not be removable by surgery, requiring post-surgical radiation treatment.

Issam Awad, MD, and Diane Maciorowski'

Maciorowski said that Awad made her feel comfortable that he had the skill to avoid or address any potential complications. His confidence and experience made the hour-long drive from Northbrook to Hyde Park worthwhile, she said.

"Any surgeon will tell you the risks, but Dr. Awad told us, 'Whatever comes up we'll be there and take care of it,'" Maciorowski said. "I'll never forget that. I really felt he was going to take care of it and I would be okay. He did a lot of these kinds of surgeries and that too was very reassuring."

Happily, the 6-hour procedure was a success. With help from cutting-edge tools such as computer-imaging guidance, tiny Doppler microprobes to monitor blood vessel pulsations and an ultrasonic aspirator to break down the tumor, Awad's team was able to remove the entire tumor from the skull base, sparing the optic nerve and carotid artery. By the time Maciorowski left the hospital for home two days later, the vision in her right eye was already returning to normal.

"She had a very complex problem and we are delighted with how she has done," said Awad, crediting his entire team. "The neuro-anesthesiologists, highly skilled nurses and technicians, postoperative critical care, all must work together, in harmony, to achieve such a result. All of that is assembled to hopefully make it a perfect performance, and this was a Carnegie Hall performance."

Two weeks after the surgery, Maciorowski passed follow-up tests by her neuroophthalmologist with flying colors. Now, she's focused on returning to teaching pre-kindergarten students next fall and enjoying time with her family. A new start, after what she described as a whirlwind, surreal experience.

"It was really scary going into it, and now sometimes when I think about it, it's almost more scary afterwards, thinking of what I just went through and what could have happened," Maciorowski said. "But now that everything's behind me, I feel great."

July 2010

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