A Syracuse teen has relief from headaches after a tumor was removed from her brain in a “first” at Upstate earlier this year.
Pediatric neurosurgeon Zulma Tovar-Spinoza MD performed a magnetic resonance image-guided laser ablation of a benign tumor called a pilocytic astrocytoma in February. She said her patient, Nazirah Trice, 17, of Syracuse, is recovering well. “Her vision is improving, as well as her balance,” Tovar-Spinoza said.
Trice developed headaches over the summer. When her mother noticed changes in her eye, she took her to an eye doctor. The eye doctor dilated the girl’s pupils and looked inside. “He stood up, walked across the hall and went and called the specialists,” Isra Muhammad remembered. The next morning, her daughter went to another ophthalmologist, who sent her directly to Upstate University Hospital.
Tovar-Spinoza said Trice’s tumor was not cancerous, but it was in a delicate location, the mid-brain. It was to the left of her thalami, an area of the brain that controls movement, near fibers that play a role in eye movement.
In researching treatment options, Tovar-Spinoza found Visualase, a Houston-based company that produces advanced laser and image-guided technologies. “What a perfect technique for this girl,” she thought, and scheduled a trip to Texas to learn more. Within a couple months, the doctor had arranged to borrow the Visualase equipment to help Trice.
Instead of a major open brain surgery, Trice underwent a minimally-invasive technique that Tovar-Spinoza said is ideal for patients who have deep and treatment-resistant tumors.
Trice was at the hospital Feb. 9 for Magnetic Resonance Imaging. The next day, her head was secured to the operating table to prevent movement, and Tovar-Spinoza made a hole in her skull about the width of a pencil. Guided by MRI images, the surgeon advanced a needle to pierce the membrane surrounding the brain, and then marked how deep the laser probe should go. “The goal is to go just inside, to the inner, deeper part of the tumor,” she said.
Once the laser was in place, Trice was moved to the MRI suite, and a new scan verified the laser’s proper position. Then Tovar-Spinoza started the ablation, sending laser energy into the tumor at 171 degrees Fahrenheit. “You move the laser in or out to make sure you are burning the whole contour of the tumor,” she explained. The body reabsorbs the tissue that the laser destroys.
The procedure lasts 30 to 45 minutes. Afterward, a single stitch seals the hole. Trice recovered in the ICU because of the potential for swelling, but Tovar-Spinoza said this procedure eventually could be done outpatient.
This laser ablation technique was used first in patients with malignant tumors that did not respond to medications. Now it is used for brain tumors and patients with lesions that cause epilepsy. The operation on Trice was the first case of a cystic tumor treated using the technique, Tovar-Spinoza said. The same technology is being used in tumors of the prostate, liver and kidneys.
The laser treats the solid part of the tumor, but in Trice’s case, a cyst containing liquid still remains. It presses on her upper brain stem, causing her vision problems. The surgeon is monitoring the cyst, which may shrink on its own. If it doesn’t, Tovar-Spinoza said she may have to place a drain.
Trice’s mother said learning of the tumor’s existence offered some relief, because they finally understood what was causing Trice’s symptoms. The prospect of brain surgery was worrisome, but she believed they were in good hands and appreciated the chance to try a new therapy. “Everybody who took care of her was great,” Muhammad said. “There was never a time when we felt like we didn’t know what was going on.”