Expert Removal of Benign Brain Tumor Spares Bride her Signature Smile
January 26, 2019
Behold the radiant smile of brain tumor survivor Aly Bobulsky on her wedding day.
Then consider that mere millimeters and the skilled hands of experienced surgeons separated this beautiful bride from even being able to smile in the first place.
The stars aligned for this nurse in University Hospitals Cleveland Medical Center’s Medical Intensive Care Unit, when otolaryngologist-neurotologist Cliff Megerian, MD, and neurosurgeon Nicholas Bambakidis, MD, carefully removed the nearly four-centimeter tumor pressing on the nerve that controls facial expression.
“With a tumor that size, it’s very, very difficult to save normal function of the facial nerve,” said Dr. Megerian, who is also President of the UH Physician Network and System Institutes. “It was a silently growing tumor, which can be very scary. If it gets too large, removal can be life-threatening.”
UH draws patients from all over the region and the country – as far away as Vancouver, Phoenix and North Carolina – for cases that demand exacting precision. In August, Dr. Bambakidis through the Congress of Neurological Surgeons conducted a two-day intensive hands-on course in skull base surgery for early-career neurosurgeons and fellows in this specialty area.
“Technically these cases are very demanding, due to the high real estate of the area with so many cranial nerves and blood vessels,” says Dr. Bambakidis, who is Director of University Hospitals Neurological Institute. “The nerve to the face is intimately involved with the tumor itself. If it’s injured, the cosmetic damage can be disfiguring.“
A Dizzying Diagnosis
Aly’s atypical symptoms began slowly, with intermittent dizziness and blinding headaches. Nothing relieved the pressure in her head. When she started to vomit from the pain, the critical care nurse knew she needed medical attention.
Her primary care physician drew a full panel of labs, performed an EKG and ordered an MRI. The imaging revealed a large tumor pressing on the auditory nerve in her ear canal and reaching the brain stem.
Dr. Bambakidis saw her the next day and was particularly surprised that the large tumor had not yet affected Aly’s hearing, which is typically the first sign of an acoustic neuroma. Acoustic neuromas usually grow slowly over many years, triggering symptoms when they press on nerves that control hearing and facial expression. A tumor large enough to interfere with the brain stem and stop the flow of cerebral spinal fluid can be fatal.
Aly also consulted with Dr. Megerian, who was amazed Aly’s hearing was not yet affected. He explained that smaller tumors of 1 centimeter or less are usually monitored without surgical intervention. Since her neuroma was already much larger than that, surgery was necessary.
In a six-hour procedure through an incision behind Aly’s ear, Drs. Megerian and Bambakidis worked together to carefully remove the tumor and salvage her smile for a wedding four months later. Steeped in the risks of serious medical procedures, Aly listened acutely when Dr. Bambakidis apprised her of the risks and reassured her of the UH team’s ability to manage the situation.
“Losing my facial nerve was definitely a worry,” said Aly, 31. “My smile is something that is so ‘me’ and the risk of having that taken away from me was scary. But my focus was simply getting through surgery and working towards recovery. I’m really grateful that my surgeons have such gifted hands.”
Regaining Her Center of Gravity
Acoustic neuromas also affect the nerve that transmits information about balance from the inner ear to the brain. Aly spent several weeks feeling like her head was not quite attached to her body. Through a month of twice-weekly physical therapy sessions, she worked herself to exhaustion learning to regain her balance and locate her center of gravity.
She was steady on her feet again in time to walk down the aisle when she married Greg Cortese, who is also a nurse in UH’s MICU. In a whirlwind year, between brain surgery and wedding festivities, she also managed to graduate with her master’s degree in nursing to become a nurse practitioner.
Their colleagues in the Medical ICU rallied around the couple, donating paid time off to Aly during her seven weeks away from work.
“My coworkers were so incredibly supportive, and fortunately, everything went textbook well,” Aly said. “I would not wish brain surgery on anyone, but the whole experience from outpatient diagnosis to ICU patient and discharge from Lerner Tower 4 through my recovery has made me a more compassionate and empathetic care provider.”