Like most single 33-year olds, Brian Prince was too active with his job and social life to give his health a second thought. Gradually he began to notice that he couldn’t hear out of his right ear. Believing that his hearing problem was simply the result of a wax buildup, Brian thought it would be cleared up quickly and routinely. After a while, he consulted his family physician.

Brian’s situation turned out to be anything but routine. Within several weeks, he was diagnosed with a meningioma, a tumor that had grown between the lining of his brain and his skull. His doctor referred him to John Leonetti, M.D., at Loyola’s Cranial Base Surgery Center.

An MRI revealed a tumor the size of a closed fist. It had engulfed Brian’s auditory nerve, as well as the cranial nerves of his mouth, right eye and ear, and grown into his carotid arteries and down his brain stem. The tumor could continue to grow, eventually destroying his sight, ability to swallow and other important motor processes.

Brian and his family had a difficult decision. Surgery to remove the complex, invasive tumor could cause more harm than leaving the tumor in place. After consulting at length with Dr. Leonetti, Douglas E. Anderson, M.D., and T.C. Origitano, M.D., Ph.D., F.A.C.S., Brian and his family opted for the surgery.

Working together, Leonetti, Anderson and Origitano designed an innovative approach for the operation that would best meet Brian’s needs. They decided that the operation would be performed over two days: on day one, they would create access to the tumor; on day two, they would start the delicate job of removing it.

During seven hours of surgery on the first day, the surgeons peeled back the skin and muscle on the right side of Brian’s face and nose and moved his eye out of place. Then they removed the right half of Brian’s skull piece-by-piece, from the midline to the cranial base. At the end of the operation, they temporarily replaced skull and flesh, allowing for easy removal the next day.

On the second day, the surgeons reopened Brian’s head. Then they attached cranial nerve monitors and painstakingly began to remove the meningioma from the surrounding tissue. After 10 hours, they had removed as much of the tumor as they could without damaging Brian’s existing function. Five percent of the tumor remained and would have to be treated with radiation therapy. The surgeons then carefully reconstructed Brian’s skull and face.

Brian spent 10 days in the hospital to receive postoperative sensory testing and physical therapy to restore his sense of balance. Then he underwent stereotactic radiation therapy to accurately destroy the remaining root of meningioma tissue and minimize the chance the tumor could reoccur. Within six months of when he was first diagnosed, Brian returned to work. His tumor was gone and, despite the complexity of his surgery and treatment, he had no lasting side effects.

Today, Brian is the same healthy, energetic young man he was prior to his unexpected ordeal. He still can’t hear out of his right ear, but he no longer faces the prospect of losing a battle with a potentially deadly brain tumor.

Loyola’s neurosciences team now has successfully performed more than two dozen operations similar to the one designed for Brian. This procedure, called a combined staged approach resection, optimizes conditions for the patient and the surgical team. The patient spends fewer consecutive hours under anesthesia and has fewer side effects. The surgical team works two shorter shifts so team members can proceed without excessive fatigue – enabling them to make their best decisions and to work with the greatest precision and speed.

As one of the leading centers in the management of skull base tumors, Loyola performs hundreds of head, neck and skull-base tumor resections each year. The Loyola specialists not only save and enhance lives in the Chicago area, they help surgeons elsewhere do the same by sharing their innovative techniques and approaches at national and international meetings and symposiums.

Close Collaboration Fosters Success

Anne Ziegenhorn was moving full speed ahead in her happy and successful life. She had her husband, their 2-year-old son and a good job as a marketing manager – and she was expecting a second child within a few months. But Anne’s life took an unexpected turn when she developed a severe headache, appeared to have a seizure and collapsed. She was rushed to a nearby hospital where her problem was diagnosed as a ruptured brain aneurysm that was leaking blood. The situation was potentially lethal for both Anne and her unborn child. Recognizing the complexity of her situation, the hospital transferred Anne to Loyola University Medical Center via the Loyola LIFESTAR helicopter.

While Anne was in transit, the Loyola neurosciences team sprang into action, preparing for her and her unborn child. When she arrived, emergency nurses and doctors stabilized Anne’s vital functions. Cerebrovascular neurosurgeons, neuroradiologists, neonatologists, obstetricians and other specialists collaborated closely to assess Anne’s situation and plan the best course of treatment.

Unless the aneurysm could be surgically repaired, every beat of Anne’s heart brought the grave possibility that it could bleed again – within an 80 percent risk of killing her and her unborn baby. However, the surgery itself could kill Anne and her 32-week old fetus, which was still too young to be delivered. All factors, options, risks and the conflicting needs of both patients had to be carefully considered. Because no single solution seemed able to address all the potential dangers, Anne’s young husband and family feared the possibility of having to choose between saving the mother or child.

After performing an angiogram, radiologists could not see the aneurysm because of the blood that surrounded it. But as Anne lay in a coma, pressure from the blood was building in her brain. Although the full diagnosis was still unclear, the first course of action had to be surgery that would relieve the pressure.

Neurosurgeons performed an operation to create a right frontal bur hole and ventriculostomy to monitor and reduce Anne’s intercranial pressure. During the procedure, neurosciences specialists, obstetricians and neonatologists carefully monitored Anne and the baby, ready to deliver if needed. Everything went as hoped; Anne and her fetus were stable.

The next step would be to deliver the baby. Roberta Karlman, M.D., a specialist in maternal fetal medicine, placed Anne on steroids for 24 hours to help the unborn child’s lungs mature more quickly and then successfully delivered a baby boy by Cesarean section. Although 4 weeks premature, the baby was healthy and received care in Loyola’s neonatal intensive care unit. Now neurosciences specialists could focus fully on saving Anne’s life.

Over the next few days, Anne came out of her coma, but the doctors kept her heavily sedated and carefully monitored her condition. During that time, Harish Shownkeen, M.D., performed an angiogram that provided a clear image of the aneurysm. Located on a major blood vessel on the right side of her brain, the aneurysm was small and thin-walled – making surgery difficult and increasing the possibility that Anne could suffer a major stroke.

After considering several options, including an endovascular coil procedure and other noninvasive techniques, the team of neurosciences specialists decided the most effective treatment was to go into Anne’s brain and seal the aneurysm with a small metal clip. During the surgery, doctors used intraoperative angiography to monitor their work and ensure each step was successful before moving ahead. The operation was a success. Three days later, the new mother was breast-feeding her new baby. A follow-up angiogram confirmed that the aneurysm was gone. Anne received physical therapy to help restore her strength and balance. Then, 23 days after arriving at Loyola, mother and baby went home.

Today, Anne shows no lasting effects from her difficult ordeal - and she and her husband, their young son and new baby are enjoying all that life has to offer.