‘Inoperable is a Relative Term’ for Brain Stem Cavernomas, Tumors, and Lesions

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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.

Few neurosurgeons attempt to operate on the brain stem, according to Jacques J. Morcos, M.D., co-chair of the Department of Neurological Surgery and director of cerebrovascular surgery and skull base tumor surgery at the University of Miami Miller School of Medicine.

Dr. Morcos leads a neurosurgery team that is one of a few in the world to 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,” said 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.”

With Dr. Morcos’ expertise, he has been able to successfully treat patients such as Vivian Michael, who had a cavernoma on the brain stem and was deemed inoperable before coming to the University of Miami Health System.

A vocalist, 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 said. “My initial instinct was something is serious. I have to get to the hospital.”

Under Dr. Morcos’ care, Michael 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,” said Dr. Morcos.

He told Michael he thought there was a chance he could remove the cavernoma using a brain surgery technique that allows him to safely access the brain stem. “Most neurosurgeons would consider this inoperable because traditionally the brain stem is thought of as a ‘no man’s land,’ ” said Dr. Morcos. “But that’s not true anymore.”

During the required month-long period between her diagnosis and surgery, Michael’s symptoms intensified. Everyday tasks like walking became difficult. Her job as a professional jazz singer was on hold. “I was temporarily disabled,” she said. “I couldn’t even lift a glass of water.”

But surgery changed all 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,” he said. “Then, with the use of intraoperative navigation, or guidance, we can place a probe.”

The day after Michael’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, Michael 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 said.

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.”