Dr. Jacques Morcos is a neurosurgeon at UHealth, the University of Miami Health System. To learn more about brain stem surgery or to make an appointment, call 305-243-6946 or visit the University of Miami's health news blog.
Vivian Michael was having an otherwise ordinary day when an undetected hemorrhage in her brain began causing stroke-like symptoms. First, she noticed a change in her speech and numbness on one side of her body. After a nap, her discomfort escalated.
“I woke up with this burning sensation in my head. When I went to get up, I just didn’t have my balance,” she says. “My initial instinct was something is serious. I have to get to the hospital.”
Under the care of Dr. Jacques Morcos, a neurosurgeon at UHealth, the University of Miami Health System, Vivian learned her symptoms were the result of a cavernoma, a cluster of blood vessels visually resembling a raspberry, that burst deep inside her brain.
“Vivian had a ruptured cavernous angioma of the brain stem, which is really a tuft of blood vessels deep in the brain stem,” says Dr. Morcos.
Dr. Morcos told Vivian he thought there was a chance he could remove the cavernoma using a brain surgery technique that allowed him to safely access the brain stem. “Most neurosurgeons would consider this inoperable because traditionally the brain stem is thought of as “no man’s land,’” says Dr. Morcos. “But that’s not true anymore.”
The brain stem is the control center for nearly all bodily functions including breathing, sleeping and consciousness. It is also the communications center for all motor and sensory functions of the entire body. But its position deep within the brain makes it a challenge to reach with traditional surgical methods. According to Dr. Morcos, few neurosurgeons attempt it.
During the required month-long period between her discovering the cavernoma and having it removed, Vivian experienced what life might be like if the surgery was not successful. Everyday tasks like walking became difficult. Her job as a professional jazz singer was on hold. “I was temporarily disabled,” she says. “I couldn’t even lift a glass of water.”
But surgery changed all of that. Using MRI-guided technology and precision surgical methods, Dr. Morcos completely removed the cavernoma. “By mapping the route before we do surgery, we know how we could access the safe entry zone into the brain stem,” says Dr. Morcos. “Then, with the use of intraoperative navigation, or guidance, we can place a probe.”
The day after Vivian’s surgery, she showed clear signs that she was on the way to a full recovery. Just a few weeks later, her life was back to normal. Dr. Morcos calls her case “remarkable.”
Today, six years after the procedure, Vivian is back to the work she loves as a singer. She sees Dr. Morcos every two years and has not had a recurrence of the cavernoma. “It was an amazing feeling to know that he didn't give up on me. I’m forever grateful,” she says.
Dr. Morcos leads a neurosurgery team at UHealth that are among a small group in the world who can perform this type of high-risk procedure. “What allows a place like ours to do this is technology, experience and a very thorough knowledge of anatomy,” says Dr. Morcos. “We have a state-of-the-art facility with a laboratory, an anatomical lab to do dissections, and the technology to image by MRI.”
This surgical procedure is also helpful for patients with lesions and tumors on the brain stem, says Dr. Morcos. “Inoperable is a relative term. It depends who's talking to you about it. When it comes to surgery on the brain stem, we can do it.”
FOCUSING ON YOU
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