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