Med­i­cal Mys­tery

Reader's Digest International - - Contents - BY SYD­NEY LONEY

THE PA­TIENT: Mahika*, a 27-year-old den­tal hy­gien­ist in New York City

THE SYMP­TOMS: Headache and blurry vi­sion

THE DOC­TOR: Dr. Raj Shri­vas­tava, a neu­ro­sur­geon and as­so­ciate pro­fes­sor at the Mount Si­nai Med­i­cal Cen­ter in New York City

MAHIKA WASN’T INI­TIALLY wor­ried when she felt a per­sis­tent throb­bing be­hind her eyes. It was Jan­uary and she had a bad cold, so she fig­ured the pain was prob­a­bly due to a si­nus in­fec­tion. She self­med­i­cated with over-the-counter pain med­i­ca­tion for a week, and when that didn’t help, she went to her fam­ily doc­tor, who put her on a course of an­tibi­otics.

Over the next two weeks, how­ever, Mahika’s headaches wors­ened, and her vi­sion grew blurry. As­sum­ing she needed a new pre­scrip­tion for her eye­glasses, she vis­ited her oph­thal­mol­o­gist. Her eyes looked fine, he said, but he couldn’t ex­plain the blurred vi­sion. By now the pain in her head was be­com­ing un­bear­able: she had trou­ble con­cen­trat­ing at work and couldn’t read or watch TV.

Mahika re­turned to her doc­tor. She’d never had a mi­graine be­fore, but her mother was prone to them, and her doc­tor sus­pected that might be the is­sue. She re­ferred Mahika to a neu­rol­o­gist, who pre­scribed trip­tan drugs, a com­mon mi­graine treat­ment that con­stricts blood ves­sels and blocks pain path­ways in the brain.

Un­for­tu­nately, that didn’t work. It had been nearly four months since her headaches be­gan, and Mahika was hav­ing trou­ble see­ing out of her left eye. Fear­ing a brain tu­mor, the neu­rol­o­gist booked an MRI. The

imag­ing re­vealed a large skull-base menin­gioma—a mass that arises from the mem­branes sur­round­ing the brain and spinal cord. It was press­ing on her op­tic nerve, caus­ing vi­sion loss, and was sur­rounded by a dense sup­ply of ar­ter­ies. A neu­ro­sur­gi­cal col­league said the tu­mor was in­op­er­a­ble and the only op­tion was ra­di­a­tion, but Mahika’s neu­rol­o­gist wasn’t ready to give up.

She re­ferred the pa­tient to Dr. Raj Shri­vas­tava at Mount Si­nai, who’d op­er­ated on dif­fi­cult cases in the past. “The pa­tient was an emo­tional wreck,” he says. “But when I saw her imag­ing, I be­lieved the tu­mor could be op­er­ated on en­do­scop­i­cally, by go­ing through her nose with a cam­era.” Ac­cord­ing to Shri­vas­tava, the ef­fi­cacy of ra­di­a­tion is only about 50 per­cent at best. Mahika was in dan­ger of losing vi­sion in both eyes, then de­vel­op­ing paral­y­sis if the tu­mor con­tin­ued to grow and press on her brain.

Over the next six days, Shri­vas­tava met with a team that in­cluded sur­geons, en­gi­neers, ra­di­ol­o­gists and com­puter sci­en­tists to de­ter­mine how to tackle the tu­mor. Us­ing ul­tra-high­field 7T MRI imag­ing, unique to Mount Si­nai’s OR pro­to­col, the team cre­ated an in­tri­cate 3-D map of the pa­tient’s brain. “It al­lowed us to plan our tra­jec­tory,” Shri­vas­tava says. “We per­formed a vir­tual surgery to de­ter­mine what an­gle we were go­ing to come in at, how much bone to drill, where each artery was, plan­ning each step in ex­quis­ite de­tail.”

On the day of the surgery, there were nine screens in the op­er­at­ing room, mon­i­tored by 10 doc­tors, who were also watch­ing the pa­tient. “It was the first time we’d in­te­grated all th­ese tech­nolo­gies into a case,” Shri­vas­tava says, not­ing that the com­plex­ity of the tu­mor spurred him to take this novel ap­proach.

Af­ter al­most 12 hours of surgery, Mahika woke with im­proved vi­sion. The doc­tors re­moved the en­tire mass, sig­nif­i­cantly re­duc­ing the risk of its re­turn. She spent three days in the hos­pi­tal and two weeks re­cov­er­ing at home. By then, the headaches were gone and her vi­sion was fully re­stored. And hap­pily, tests con­firmed that the tu­mor was be­nign.

“Ev­ery­thing went ac­cord­ing to plan,” Shri­vas­tava says. “With the help of tech­nol­ogy, neu­ro­surgery is leav­ing less to im­pro­vi­sa­tion. As for the pa­tient, this had been such an over­whelm­ing ex­pe­ri­ence that she didn’t be­lieve the tu­mor was ac­tu­ally gone—she was very, very happy.”

Two years later, Mahika is still healthy—and hap­pily tu­mor-free.

Af­ter al­most 12 hours of surgery, Mahika awoke with im­proved

vi­sion.

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